Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience


Submitted: 15 December 2019
Accepted: 24 October 2020
Published: 1 February 2021
Abstract Views: 1546
PDF: 561
HTML: 14
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Fowler-Stephens Laparoscopic Orchiopexy (FSLO) permits the mobilization of Intra-Abdominal Testis (IAT) to the scrotal position after spermatic vessel ligation. We reported our experience of FSLO for IAT. The charts of all boys who underwent a FSLO were retrospectively reviewed. Data were analysed for demographic data, procedure, complications and follow-up results. From January 2008 to June 2016, 160 laparoscopies for Non Palpable Testis (NPT) were performed at a mean age of 3,2 years. 61% of patients had a right NPT, while 6% were bilateral. In 64 cases, an IAT was found: 20 were managed by FSLO with a two-stage procedure in 11 patients. There were no differences in hospitalisations; one patient had a prolonged ileus. Follow-up ranged from 1 to 8 years. Of the 20 patients who underwent FSLO, testicular atrophy developed in three; the remaining testes were in the scrotal position, with normal consistency. FSLO was applied in 31% of IAT. The overall success rate of the technique was 85 %. The percentage of atrophy associated after spermatic vessels interruption appears to provide a good chance of testicular survival.


Papparella A, Coppola S, Nino F, et al. Epidemiology and treatment of cryptorchidism and retractile testis: retrospective study in the area of Naples. Minerva Pediatr. 2013; 65(1): 77-82.

Cobellis G, Noviello C, Nino F, et al. Spermatogenesis and cryptorchidism. Front Endocrinol 2014 May 1; 5:63. DOI: https://doi.org/10.3389/fendo.2014.00063

Diamond DA, Caldamone AA. The value of laparoscopy for 106 impalpable testes relative to clinical presentation. J. Urol. 1992; 148: 632-4. DOI: https://doi.org/10.1016/S0022-5347(17)36675-2

Papparella A, Parmeggiani P, Cobellis G, et al. Laparoscopic management of nonpalpable testes: A multicenter study of the Italian Society of Video Surgery in Infancy J Ped Surg 2005; 40: 696-700. DOI: https://doi.org/10.1016/j.jpedsurg.2005.01.010

Papparella A, Romano M, Noviello C, et al. The value of laparoscopy in the management of non-palpable testis. J Pediatr Urol. 2010; 6:550-4. DOI: https://doi.org/10.1016/j.jpurol.2009.12.010

Fowler R, Stephens FD. The role of testicular vascular anatomy in the salvage of high undescended testis. Aust NZ J Surg 1959;29: 32-5. DOI: https://doi.org/10.1111/j.1445-2197.1959.tb03826.x

Ransley PG, Vordemark JS, Caldamone AA, et al. Preliminary ligation of the gonadal vessels prior to orchidopexy for the intraabdominal testicle: a staged Fowler - Stephens procedure. World J Urol 1984; 2:266-268. DOI: https://doi.org/10.1007/BF00326700

Bloom DA. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 1991; 145:1030-3. DOI: https://doi.org/10.1016/S0022-5347(17)38522-1

Papparella A, Nino F, Coppola S, et al. Morphological changes due to pneumoperitoneum: the effect of Intra-abdominal Pressure. Eur J Pediatr Surg. 2014; 24:322-27. DOI: https://doi.org/10.1055/s-0033-1349057

Caldamone AA, Amaral JE Laparoscopic Stage 2 Fowler-Stephens orchiopexy. J Urol 1994; 152:1253-6. DOI: https://doi.org/10.1016/S0022-5347(17)32562-4

Alagaratnam S, Nathaniel C, Cuckow P, et al. Testicular outcome following laparoscopic second stage Fowler Stephens orchidopexy Journal of Pediatric Urology 2014; 10, 186-192. DOI: https://doi.org/10.1016/j.jpurol.2013.08.005

Diamond DA. Laparoscopic orchiopexy for the intra-abdominal testis. J Urol, 1994,152: 1257-8. DOI: https://doi.org/10.1016/S0022-5347(17)32563-6

Jordan G H, Winslow BH. Laparoscopic single stage and staged orchidopexy. J Urol 1994; 152:1249-52. DOI: https://doi.org/10.1016/S0022-5347(17)32561-2

Franco I, Lindgren BW Laparoscopic Fowler–Stephens orchidopexy for the high abdominal testis. J Urol 1999; 162: 990-994 DOI: https://doi.org/10.1016/S0022-5347(01)68042-X

Elyas R., Guerra L. A., Pike J, et al. Is Staging Beneficial for Fowler-Stephens Orchiopexy? A Systematic Review. J Urol 2010;183 :2012-19. DOI: https://doi.org/10.1016/j.juro.2010.01.035

Bagga D, Prasad A, Grover SB, et al. Evaluation of two-staged Fowler-Stephens laparoscopic orchidopexy (FSLO) for intra-abdominal testes (IAT). Ped Surg Int. 2018; 34:97-103. DOI: https://doi.org/10.1007/s00383-017-4170-8

Hvistendahl GM, Poulsen EU. Laparoscopy for the impalpable testes: experience with 80 intra-abdominal testes. J Pediatr Urol 2009; 5:389-92. DOI: https://doi.org/10.1016/j.jpurol.2009.04.004

Baker LA, Docimo SG, Surer I, et al. A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 2001; 87:484-9. DOI: https://doi.org/10.1046/j.1464-410X.2001.00127.x

Ostlie DJ, Leys CM, Fraser JD, et al. Laparoscopic Orchiopexy Requiring Vascular Division: A Randomized Study Comparing the Primary and Two-Stage Approaches. J Laparoendosc Adv Surg Tech A. 2015; 25:536-9. DOI: https://doi.org/10.1089/lap.2015.0183

Papparella A. Noviello C. Amici G, Parmeggiani P. Laparoscopic Fowler-Stephens procedure is contraindicated for intraabdominal major duct anomalies. Surg Endosc 2004;18 (8):1-4. DOI: https://doi.org/10.1007/s00464-002-4274-6

Rosito NC, Koff WJ, da Silva Oliveira TL, et al. Volumetric and histological findings in intra-abdominal testes before and after division of spermatic vessels. J Urol. 2004; 171:2430-3. DOI: https://doi.org/10.1097/01.ju.0000125242.43762.be

Papparella, A., De Rosa, L., & Noviello, C. (2021). Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience. La Pediatria Medica E Chirurgica, 42(2). https://doi.org/10.4081/pmc.2020.224

Downloads

Download data is not yet available.

Citations