Hydrocele & Testicular Cancer

  My 7 year old son recently underwent surgery for a hydrocele on his right side.  During the operation, it was determined that a hydrocele also existed on the left side.  1 1/4 incisions were made in the crease on each side below the stomach as well as a small incision in the right scrotum.  I subsequently have heard too many adults express surprise that the need for this surgery was not detected until 7 years after his birth and that the possibility for testicular cancer later in life increases if this surgery is performed later as opposed to sooner (ages 2-4).  Since my son's right testical was larger than his left since birth, should the need for this surgery have been determined earlier?  What ramifications, if any, are present or potentially present as a result of this surgery being performed 7 years after birth?

[hfhs M.D.-AK]

Dear Thomas
I think you have been misinformed by your friends and other adults.  A hydrocele is an accumulation of fluid inside the sac that houses the testicles.  This sac is called the tunica vaginalis.  The fluid usually does not cause the testicle any harm nor does it increase the risk of testicular cancer.  A hydrocele is a benign process.  In fact, many hydroceles if they are stable(not fluctuating in size), do not even get operated on.  The indications for surgery are pain, communication with the abdomen, or discomfort from the hydrocele being too large.
It would be important to close the hydrocele if it fluctuated in size and communicated with the abdomen essentially this is a hernia.  These hydroceles, secondary to a hernia, are often repaired while the child is an infant because they are not thought to resolve and could enlarge or allow bowel to be trapped.  Again, either situation would have no increased risk for cancer.
To address your comment on one testicle being larger than the other.  There is some amount of size difference that is acceptable.  Without examining your child directly, I would be concerned that your idea of size difference was due to the hydrocele, when in reality, the testicles themselves are very close in size.  If you are still concerned, an ultrasound of the scrotum to assess the size of each testicle and confirm that there is no cancer could be done.  Although, a good physical exam by a urologist could also tell you the same thing.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Testicular cancer