Laparoscopic Two Stage Fowler-Stephens Orchiopexy: A Single Center Experience

Mahziyar Khazaeli, Dinyar Khazaeli, Hayat Mombeini, Peyman Asadinia, Mohammad Bahadoram

Abstract


Introduction: Cryptorchidism is one of the most common congenital anomalies of testis. Risk of cancer and reduced fertility urge the treatment of this disease in infancy. A technical surgical problem regarding intra-abdominal testes is the existence of short spermatic cords that prevent the testes from repositioning into the scrotum. The Fowler-Stephens method addresses this issue by suggesting the excision of the spermatic artery, yet it is not popular with urologists due to the risk of testicular atrophy.

Patients and Methods: The present study followed a descriptive cross-sectional design where patients with intra-abdominal cryptorchidism were examined through exploratory laparoscopy, and those who were candidates for orchiopexy underwent a two-stage Fowler-Stephens surgery. The first stage included spermatic artery ligation using Weck clips. The second stage, which followed 4-6 months later, included laparoscopic mobilization of testis based on vasa deferential artery. One to three months after the second stage, the patients were re-examined through color Doppler sonography. Success was defined as testis repositioning in the dependent portion of the scrotum with no atrophy.

Results: Out of the 24 patients who underwent surgery, 22 responded well to the operation, but two showed testis atrophy. The average patient follow-up schedule and average interval between the two stages were 2.17 and 4.8 months, respectively. Surgery success rate for our patients was 83.3%.

Conclusions: Two-stage Fowler-Stephens laparoscopic orchiopexy is a safe method for high intra-abdominal testis orchiopexy, where standard orchiopexy might lead to improper positioning of the testis and testis atrophy due to excess tension on spermatic cord.  

Keywords: Orchiopexy, Cryptorchidism, Laparoscopy, Two Stage Fowler-Stephens


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References


Docimo SG, Silver RI, Cromie W. The undescended testicle: diagnosis and management. American family physician. 2000;62(9):2037-44, 47-8.

Novaes HF, Carneiro Neto JA, Macedo A, Jr., Barroso Junior U. Single scrotal incision orchiopexy - a systematic review. International braz j urol : official journal of the Brazilian Society of Urology. 2013;39(3):305-11.

Cloutier J, Moore K, Nadeau G, Bolduc S. Modified scrotal (Bianchi) mid raphe single incision orchiopexy for low palpable undescended testis: early outcomes. The Journal of urology. 2011;185(3):1088-92.

Abaci A, Catli G, Anik A, Bober E. Epidemiology, classification and management of undescended testes: does medication have value in its treatment? Journal of clinical research in pediatric endocrinology. 2013;5(2):65-72.

Bittencourt DG, Miranda ML, Moreira AP, Miyabara S, Bustorff-Silva JM. The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis. International braz j urol : official journal of the Brazilian Society of Urology. 2003;29(4):345-51; discussion 51-2.

Shehata SM, Shehata SM, M ABF. The intra-abdominal testis: lessons from the past, and ideas for the future. Pediatric surgery international. 2013;29(10):1039-45.

Esposito C, Caldamone AA, Settimi A, El-Ghoneimi A. Management of boys with nonpalpable undescended testis. Nature clinical practice Urology. 2008;5(5):252-60.

Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. The Journal of urology. 1995;154(3):1148-52.

Chang M, Franco I. Laparoscopic Fowler-Stephens orchiopexy: the Westchester Medical Center experience. Journal of endourology / Endourological Society. 2008;22(6):1315-9.

Elyas R, Guerra LA, Pike J, DeCarli C, Betolli M, Bass J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. The Journal of urology. 2010;183(5):2012-8.

Wayne C, Chan E, Nasr A, Canadian Association of Paediatric Surgeons Evidence-Based R. What is the ideal surgical approach for intra-abdominal testes? A systematic review. Pediatric surgery international. 2015;31(4):327-38.

Gatti JM, Ostlie DJ. The use of laparoscopy in the management of nonpalpable undescended testes. Current opinion in pediatrics. 2007;19(3):349-53.

Hvistendahl GM, Poulsen EU. Laparoscopy for the impalpable testes: experience with 80 intra-abdominal testes. Journal of pediatric urology. 2009;5(5):389-92.

Abolyosr A. Laparoscopic versus open orchiopexy in the management of abdominal testis: a descriptive study. International journal of urology : official journal of the Japanese Urological Association. 2006;13(11):1421-4.


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