Pediatric Hydrocele--Need for Surgery?

Is there a medical consensus as to whether hydrocele requires operation if it does not resolve by 12 months of age? I have read various medical articles from leading institutions: some say to wait until after 18 months, others 2 years, others 6 years---on the theory that it can still self-resolve or that the child will be better prepared to handle general anesthesia.  

My child is now 14 months old.  The hydrocele is pain-free, located on the right side and was not noticeable until about 12 months of age.  A local pediatric urologist said that he performs surgery immediately after the 12 month marker has passed. I have previously had bad experiences with general anesthesia, and the thought of surgery and general anesthesia for my child scares me.  

Is there any possibility of self-resolution past 12 months?  In the alternative, is there a less-invasive treatment (such as ultrasound evaluation, aspiration, injection or endoscopy)?  If surgery is still recommended, when is the ideal age for surgery?  How long can we wait to see if it will resolve?  Is surgery recommended for both sides even though the left side evidences no symptoms?

[Kevin Pho, MD]

The management of noncommunicating hydrocele in a neonate or child younger than two years of age is supportive; communicating hydroceles rarely resolve and pose a risk for development of incarcerated inguinal hernia.

Surgical repair is necessary if the child is older than two years of age or the scrotum is tense, which may reduce circulation to the testicles. Appropriate therapy should be provided for the primary condition if one is present (eg, epididymitis, orchitis, testicular torsion, trauma, or tumor).

As to how long you can wait and the specific question of whether to operate on both sides, this is dependent on the patient, and I cannot comment on this without being personally involved in the case.

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.

Bibliography:
Brenner et al. Testicular and scrotal masses in children and adolescents.  UptoDate, 2004.