Editing External Genital Anomalies in Boys (section)

=== Diagnosis and Evaluation ===
* '''History and Physical Exam'''
** '''History'''
*** Typically manifests as a '''painless bulge found in the groin or extending along the cord to the scrotum.'''
**** '''The bulge may be present only during periods of increased intra-abdominal pressure (crying or bowel movements'''
***** '''The presence of an intermittent bulge helps to distinguish a reducible inguinal hernia and communicating hydrocele from a scrotal hydrocele or hydrocele of the spermatic cord'''.
***** '''The child with an incarcerated inguinal hernia will be irritable or inconsolable and have a persistent or larger bulge without spontaneous reduction and may have decreased appetite and signs of bowel obstruction (abdominal distention, vomiting, and lack of flatus or stool)'''
** '''Physical Exam'''
*** '''The supine position facilitates reduction of peritoneal fluid and intra-abdominal contents'''
*** '''The hydrocele fluid surrounding the testicle should transilluminate; however, neonatal bowel may also transilluminate.'''
*** The hydrocele of the spermatic cord is usually painless and variable in size. It may be confused for the testis because of its round-oval shape
* '''Imaging'''
** '''Often of limited use'''