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

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


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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