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Pediatrics/regarding bilateral hydronephrosis and communicating hydrocele in 3 month old male child



My 3 months old son has been diagnosed with bilateral hydronephrosis and bilateral hydrocele both of them being congenital.  we are keeping a track on both of them and have got a ultrasound done for the same.
Ultrasound scrotum result for hydrocele done recently are right testis measures 1.36 x 1.13 cms and left testis measures 0.87 x 0.85 cms.  moderate fluid collection seen in both scrotum suggestive of hydrocele. on physical examination, left side hydrocele is much more than on the right and transillumination test is positive.  the scrotum on left side is tight and firm. there has been a size variation since birth in the initial 2 months it was regressing but now the left hydrocele has increased in size and the right hydrocele has reduced.

for the KUB ultrasound the antenatal reports at 35 week have shown AP diameter of renal pelvis as  11 mm on right and 8 mm on left.  ultrasound at the age of 25 weeks for son has shown left pelvis AP diameter as 8.3 mm and right as 5.3 mm without any renal calculi or urinary bladder abnormality.  recent ultrasound done at the age of 3 months revealed right kidney Ap diameter as 0.3 cms and left kidney as 1.1 cms.  there are no other signs or symptoms clinically

So what in your opinion would be the most suitable treatment option for hydrocele and hydronephrosis.  please suggest.  and can we delay the surgery for hyrocele as he is too young and so would like to wait for another 3-4 months.  can there be any risk involved if we delay the surgery for hydrocele.  please suggest.

Thanks and regards

ANSWER: Hi, monica,

The hydrocele is not generally a problem, and is only bothersome to parents because it is easily visible.  Following it is fine.

Bilateral congenital hydronephrosis in a male needs to be evaluated for reflux and a consideration made for posterior urethral valves.  Bilateral UPJ obstruction is another possibility.  Some people would cover for infection with a daily antibiotic to prevent infection.  

There are a lot of diagnostic studies that could be done, such as a VCUG or other study to rule out reflux. The main thing is to follow with ultrasound to be sure this is not progressing.

I appreciate I am not being very specific on this and gave you a lot of acronyms to look up, but the state of the art of this problem still is a bit up in the air.  

Good luck, Dr. Olson

---------- FOLLOW-UP ----------

QUESTION: Hi Dr, Olson,

Thanks for answering.  actually my basic concern is that the hydrocele on left side has increased in size in past 15 days and has become tight and hard though the recent ultrasound done 5 days ago didnt reveal any other pathology other than the hydrocele.  so the pediatric surgeon has recommended surgery for the hydrocele as he says that it can lead to hernia or torsion of testis.  but I don't wanna get the surgery done as my son is still 3 months old.  so, how long can I wait for the surgery safely and is it really that important to get the surgery done as I wanna give it a try with alternative therapy (homeopathy)?  So, can a hydrocele create complication in such a small child if left for 5-6 months without surgery and it is not growing in size now, please suggest?

Thanks & regards

Hi, monica,

A huge, expanding hydrocele can cause the problems that your doctor is describing.  I can't tell you how long to wait, for this is dependent on a number of factors that a "doctor on the ground" can tell you.  It sounds like it needs to be treated and this should be safe and effective, as long as it is done by a good PEDIATRIC urologist.  Homeopathy has no role here.  

Good luck, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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