title: Definitive identification of a patent processus vaginalis by intraoperative injection of methylene blue into the hydrocoele sac.
abstract: 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.
authors.affiliation: Department of Urology, Harold Wood Hospital, Gubbins Lane, Romford, Essex RM3 0BE, UK. johngcall@aol.com
authors.forename: John G
authors.initials: JG
authors.lastname: Calleary
authors.forename: Oliver
authors.initials: O
authors.lastname: Wiseman
authors.forename: Junaid
authors.initials: J
authors.lastname: Masood
authors.forename: James T
authors.initials: JT
authors.lastname: Hill
mesh_terms: 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*
chemical_list: D004791:Enzyme Inhibitors; D008751:Methylene Blue