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  • Title: Definitive identification of a patent processus vaginalis by intraoperative injection of methylene blue into the hydrocoele sac.
    Author: Calleary JG, Wiseman O, Masood J, Hill JT.
    Journal: J Pediatr Urol; 2008 Jun; 4(3):218-20. PubMed ID: 18631930.
    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.
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