A multi‐institutional analysis of laparoscopic orchidopexy

Abstract

Objective To combine and analyse the results from centres with a large experience of laparoscopy for the impalpable testis with small series, to determine the expected success rate for laparoscopic orchidopexy. Methods A questionnaire was distributed to participating paediatric urologists; each contributor retrospectively reviewed the clinical charts for their cases of therapeutic laparoscopy for an impalpable testis, detailing 36 variables for each patient. The data were collated centrally into a computerized database. For inclusion, the testis was intra-abdominal (including 'peeping' at the internal ring) at laparoscopic examination, was not managed through an open approach and did not undergo orchidectomy. Three surgical groups were assessed, with success defined as lack of atrophy and intrascrotal position: group 1, primary laparoscopic orchidopexy; group 2, a onestage Fowler-Stephens (F-S) orchidopexy; and group 3, a two-stage F-S orchidopexy. Results Data were gathered from 10 centres in the USA, covering the period 1990-1999; 252 patients representing 310 testes were included and overall, 15.2% were lost to follow-up. There was no significant difference between success rates in the larger and smaller series. Atrophy occurred in 2.2% of 178 testes, 22.2% of 27 testes and 10.3% of 58 testes in groups 1-3, respectively. Testes were not in a satisfactory scrotal position in 0.6%, 7.4% and 1.7% of groups 1-3, respectively. The mean follow-up for each group was 7.7, 8.6 and 20.0 months, respectively. The overall success for all groups was 92.8% (97.2% group 1; 74.1% group 2; 87.9% group 3), with an atrophy rate of 6.1%. Conclusion Laparoscopic orchidopexy for the intraabdominal testis, in both large and small series, can be expected to have a success rate higher than that historically ascribed to open orchidopexy. Within this series, single-stage F-S laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the two-stage repair. However, when considering both F-S approaches, the laparoscopic approach gave greater success than previously reported for the same open approaches. Despite the weaknesses inherent in a retrospective unrandomized study, we conclude that laparoscopic orchidopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testicle.

Age at Surgery and Outcomes of an Undescended Testis

“…To date, the only other published multicenter study (10 sites, n = 281 patients) reported overall 7.2% and 6.1% rates of failure and atrophy, respectively, in patients undergoing laparoscopic orchidopexy. 21 We found that at least two-thirds of corrective surgeries for UDT were 5 Values are expressed as n (%). a Some simultaneous orchidopexy and orchiectomy.…”

Laparoscopic diagnosis and treatment of nonpalpable testis

“…One should be aware of the inferior results of the laparoscopic primary orchiopexy with vascular ligature (primary or one stage Fowler-Stephens). In the literature (20), the reported success was 74.1%. In our series, with the exception of a few cases, we only reached 33% of well located and normal testes.…”

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

“…50 The laparoscopic FS orchidopexy entails division of the gonadal vessels and cremasteric collaterals during advancement of the IAT medial to the inferior epigastric vessels or obliterated umbilical artery. Despite its widespread use, [51][52][53][54] either as a one-or two-stage procedure, atrophy rates can be as high as 33%, probably due to failure of developing adequate collateral blood supply through the deferential artery. The presence of a long looping vas deferens may increase this risk, especially when the procedure is done laparoscopically.…”