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Urology (Expert Forum)
Pediatric Hydrocele--Fix One Side or Both?
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Pediatric Hydrocele--Fix One Side or Both?
by sacrecoeur, May 03, 2004 12:00AM
We have decided to follow the urologist's advice and perform a hydrocelectomy on my 14th month old son in the next couple of weeks. His right side has hydrocele, his left side currently does not.
The urologist said that although his left side is currently fine, he usually operates on both sides regardless. It has been his experience that up to 50% of his patients who only do one side return within 2 years needing surgery on the other side. We have to tell him our preference by the end of the week.
However, some internet research indicates studies with rates of only 7-10% of the other side flaring up later, and one study in particular recommends against doing bilateral surgery if only one side evidences hydrocele.
The pro of doing both sides is not having to worry about it again---no repeat surgery. The cons of both sides are 1) longer exposure to anesthesia and 2) if there is a surgical problem, complete infertility may result (and may not be discovered for many years).
I do not want to have to go through another surgery for him, but I also do not want to do anything medically unnecessary now and risk the cons.
What is the currently accepted thinking on this? Is bilateral surgery recommended even if only one side evidences hydrocele? Statistics? Thoughts on the realities of the pros and cons that I mentioned?
Thank you.
The urologist said that although his left side is currently fine, he usually operates on both sides regardless. It has been his experience that up to 50% of his patients who only do one side return within 2 years needing surgery on the other side. We have to tell him our preference by the end of the week.
However, some internet research indicates studies with rates of only 7-10% of the other side flaring up later, and one study in particular recommends against doing bilateral surgery if only one side evidences hydrocele.
The pro of doing both sides is not having to worry about it again---no repeat surgery. The cons of both sides are 1) longer exposure to anesthesia and 2) if there is a surgical problem, complete infertility may result (and may not be discovered for many years).
I do not want to have to go through another surgery for him, but I also do not want to do anything medically unnecessary now and risk the cons.
What is the currently accepted thinking on this? Is bilateral surgery recommended even if only one side evidences hydrocele? Statistics? Thoughts on the realities of the pros and cons that I mentioned?
Thank you.
Doctor's Answer
by Kevin Pho, MD, May 04, 2004 12:00AM
, May 04, 2004 12:00AM
Hydroceles usually develop as a result of failure of the processus vaginalis to close during development. Studies have shown that there is a high percentage of positive contralateral operative findings (72% in our series), and a very low incidence of significant morbidity following contralateral repair.
There are no clear guidelines regarding when to do contralateral repair. The decision is influenced by the experience of the surgeon as well as the medical center as well as the abscence of any co-morbid disease states that can worsen surgical outcome.
Before making this decision, you may want to consider a second opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
There are no clear guidelines regarding when to do contralateral repair. The decision is influenced by the experience of the surgeon as well as the medical center as well as the abscence of any co-morbid disease states that can worsen surgical outcome.
Before making this decision, you may want to consider a second opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
