Hydrocele stone presentation and crystallographic analysis: a unique case report.

Introduction and importance: Hydroceles are typically benign fluid collections around the testes. Rarely, scrotal calculi, or "hydrocele stones," form within the tunica vaginalis, possibly due to chronic inflammation, torsion of the appendix testis, minor trauma, or other mechanisms. These stones are infrequently reported, and cases with detailed crystallographic analysis are exceptionally rare. Case presentation: We present a 43-year-old male with bilateral hydroceles, a history of psoriasis and dyslipidemia, and prior right inguinal hernia repair. Ultrasound revealed a moderate right hydrocele and a small left hydrocele containing a 3 mm echogenic hydrocele stone, later found to measure 5 mm on direct intraoperative measurement. The patient underwent bilateral hydrocelectomy, during which the left hydrocele stone was retrieved. Crystallographic analysis revealed that the stone was composed of 80% calcium carbonate phosphate and 20% calcium carbonate. Postoperative recovery was uneventful. Clinical discussion: Scrotal calculi are generally asymptomatic and often discovered incidentally during imaging or surgery. Their formation may involve inflammation, torsion, trauma, or parasitic infections. Crystallographic analysis provides valuable insights into stone composition, helping to distinguish these rare lesions from other scrotal pathologies. Conclusion: Although hydrocele stones are rare and usually benign, further studies are needed to elucidate their pathogenesis, composition, and prevalence. Reporting such cases contributes to the understanding of this uncommon entity and aids in clinical recognition.