Definitive identification of a patent processus vaginalis by intraoperative injection of methylene blue into the hydrocoele sac.
OBJECTIVE
Seven percent of patent processus vaginalis (PPVs) are obliterated at exploration. This potentially increases the risk of cord injury with a subsequent increased risk of testicular atrophy or reduced fertility. We report a modification of a technique to improve identification of the PPV and thus potentially minimise the risk to the cord.


METHODS
Fifteen consecutive boys were operated on via a standard inguinal approach. The testicle was delivered and 0.2-0.5 ml of a 50% methylene blue/normal saline solution was injected into the hydrocoele sac. A PPV is identified as a blue line.


RESULTS
Methylene blue injection identified all PPV. In a case with an encrusted hydrocoele of the cord and a hydrocoele this anatomy was clearly delineated. Dissection in a recurrent case was better facilitated. No testicular atrophy was recorded and there were no significant complications.


CONCLUSIONS
Intraoperative injection of a methylene blue solution into a hydrocoele sac will aid identification of a difficult PPV, thus minimising the risk of cord damage. This is especially helpful in cases of recurrent hydrocoele.
Calleary
John G
JG
Department of Urology, Harold Wood Hospital, Gubbins Lane, Romford, Essex RM3 0BE, UK. johngcall@aol.com
Wiseman
Oliver
O
Masood
Junaid
J
Hill
James T
JT
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007272:Injections, Intralymphatic; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage*; D016343:Monitoring, Intraoperative / Q000379:methods*; D006848:Testicular Hydrocele / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D013737:Testis / Q000002:abnormalities*; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
D004791:Enzyme Inhibitors; D008751:Methylene Blue