# Hydrocele (Evaluation & Management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: EAU Guidelines on Paediatric Urology 2023 · MSF Essential Drugs 2024 - paracetamol (oral) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) ## Treatment metadata - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text HYDROCELE (EVALUATION & MANAGEMENT) Sources: EAU Guidelines on Paediatric Urology 2023 · MSF Essential Drugs 2024 - paracetamol (oral) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Most patients present with painless swelling of the scrotum [scrotal swelling] - A congenital hydrocele often comes and goes, shrinking when lying flat as fluid drains into the abdomen, but pressing on it does not reduce it - Because it is painless, a primary hydrocele can grow very large before the patient seeks care - Living in a hot climate is a recognized predisposing factor SIGNS - what you find (4) - The swelling makes the testis impalpable and transilluminates with a positive fluctuation test - Being unable to feel above the swelling and palpate the cord suggests hydrocele or hernia rather than another cause [hernia] - A hydrocele envelops both testis and epididymis, making neither separately palpable - A secondary hydrocele is usually smaller than a primary one, except when caused by filariasis TESTS (7) - The diagnosis is usually made clinically; labs and imaging are reserved for excluding other conditions - A raised white cell count and a negative transillumination point toward an incarcerated hernia rather than a hydrocele - Alpha-fetoprotein and hCG levels are checked when a testicular tumor such as malignant teratoma is suspected - Urinalysis and culture can help when epididymitis or orchitis is producing a reactive hydrocele - On ultrasound, a hydrocele looks like an anechoic (echolucent) area surrounding the testis - Doppler flow is reduced or absent when a hydrocele results from testicular torsion, but increased when it follows epididymitis - Plain abdominal x-ray may show bowel gas overlying the groin in an incarcerated hernia IF NOT THIS - what else fits (4) - An inguinal hernia has an expansile cough impulse and can be reduced, but lacks transillumination and fluctuation - A testicular tumor may be suspected when alpha-fetoprotein or hCG markers for a malignant germ cell tumor are raised - A spermatocele, testicular tumor, and testicular atrophy can each be told apart from hydrocele on ultrasound - A varicocele shows Valsalva-augmented regurgitant flow on duplex ultrasound, unlike a hydrocele Source StatPearls "Hydrocele" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) Peds 10-15 mg/kg/dose [child max 500 mg] (Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily); Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily)) 3kg -> 30-45 mg/dose 4kg -> 40-60 mg/dose 5kg -> 50-75 mg/dose 6kg -> 60-90 mg/dose 7kg -> 70-105 mg/dose 8kg -> 80-120 mg/dose 9kg -> 90-135 mg/dose 10kg -> 100-150 mg/dose 11kg -> 110-165 mg/dose 12kg -> 120-180 mg/dose 13kg -> 130-195 mg/dose 14kg -> 140-210 mg/dose 15kg -> 150-225 mg/dose 16kg -> 160-240 mg/dose 17kg -> 170-255 mg/dose 18kg -> 180-270 mg/dose 19kg -> 190-285 mg/dose 20kg -> 200-300 mg/dose 21kg -> 210-315 mg/dose 22kg -> 220-330 mg/dose 23kg -> 230-345 mg/dose 24kg -> 240-360 mg/dose 25kg -> 250-375 mg/dose 26kg -> 260-390 mg/dose 27kg -> 270-405 mg/dose 28kg -> 280-420 mg/dose 29kg -> 290-435 mg/dose 30kg -> 300-450 mg/dose 31kg -> 310-465 mg/dose 32kg -> 320-480 mg/dose 33kg -> 330-495 mg/dose 34kg -> 340-500 mg/dose (upper capped) 35kg -> 350-500 mg/dose (upper capped) 36kg -> 360-500 mg/dose (upper capped) 37kg -> 370-500 mg/dose (upper capped) 38kg -> 380-500 mg/dose (upper capped) 39kg -> 390-500 mg/dose (upper capped) 40kg -> 400-500 mg/dose (upper capped) 41kg -> 410-500 mg/dose (upper capped) 42kg -> 420-500 mg/dose (upper capped) 43kg -> 430-500 mg/dose (upper capped) 44kg -> 440-500 mg/dose (upper capped) 45kg -> 450-500 mg/dose (upper capped) 46kg -> 460-500 mg/dose (upper capped) 47kg -> 470-500 mg/dose (upper capped) 48kg -> 480-500 mg/dose (upper capped) 49kg -> 490-500 mg/dose (upper capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Simple analgesic for scrotal heaviness or discomfort while a hydrocele is evaluated; it does not treat the hydrocele itself, which is managed conservatively if asymptomatic and non-communicating or referred for surgery if large, painful, or communicating. Caution Asymptomatic non-communicating hydroceles in adults require conservative management and reassurance. Perform transillumination exam and scrotal ultrasound to rule out underlying testicular tumor or epididymitis. Refer for surgical hydrocelectomy if large, painful, or communicating. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)