Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler–Stephens procedure

Ellis, Rebecca; Lahiri, Rajiv; Mahomed, Anies

doi:10.1007/s00464-014-3574-y

Cited by 13 publications

(9 citation statements)

References 7 publications

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“…In our series of IAT the success rate of treatment by 2SLF-SO was 93%. In the literature success rates of this treatment approach range from 86% to 100% [14][15][16][17][18][19][20][21][22] and do not differ much from success rates of orchidopexy for canalicular UDT (92.0-97.4%) [23,24]. After 2SLF-SO testicular viability depends on collateral blood supply from the inguinal canal vessels, gubernacular vessels, and hypertrophy of the artery of the vas.…”

Section: Discussionmentioning

confidence: 99%

“…After 2SLF-SO testicular viability depends on collateral blood supply from the inguinal canal vessels, gubernacular vessels, and hypertrophy of the artery of the vas. To decrease the incidence of testicular atrophy after the laparoscopic F-S operation, a gubernaculum testis and cremasteric vessels preservation technique was invented recently [ 15 , 16 , 20 , 22 ]. However, the results of the laparoscopic F-S operation with or without preservation of gubernacular vessels are comparable (88–100% vs. 88.8–96.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Most researchers assess the viability of testes and testicular atrophy by palpation [ 15 , 20 , 22 ]. Such a subjective examination allows only an estimated comparison of volumes between the affected and healthy testis.…”

Section: Discussionmentioning

confidence: 99%

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The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes

et al. 2019

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Introduction: The aim of our study was to evaluate testicular growth and risk of atrophy at different lengths of time from the 2SLF-SO in boys with intra-abdominal cryptorchidism. Material and methods: Twenty-seven boys aged one to 24 months were treated for 35 non-palpable testes. Twenty-one boys with 29 IAT underwent a two-stage laparoscopic Fowler-Stephens operation. The patients underwent ultrasound examination of the TV at six time points: before treatment (TP1), 3 months (TP2) and 9-12 months after laparoscopic F-S operation (TP3), 3 months after inguinal orchidopexy (TP4), 3-6 years of age (TP5) and 7-9 years of age (TP6). The testicular atrophy index (TAI) of the affected testicle was calculated. Results: The overall success rate of treatment was 93.1% (27/29). The median volume of the affected testicles before treatment was less than the median TV of the healthy gonad, but increased systematically at the successive time points, showing significant growth between the second and sixth time points (p < 0.02, R = 2.75). The median TAI value decreased at the subsequent time points from the level of 26% at TP1 to 5.4% at TP6, with no significant difference. Conclusions: Two-stage laparoscopic Fowler-Stevens operation proved to be an effective procedure for the treatment of intra-abdominal testicles. The undescended testis had a chance to grow and to equalize with the healthy testis after this procedure. The incidence of testicular atrophy was low.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes

et al. 2019

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“…In an interesting study with patients undergoing a second-stage FS procedure the authors photographed prior to pexy of the testis in the Dartos pouch. The photographs were evaluated for the extent of vascular collateralization between gubernacular, deferential and the ligated spermatic artery, and concluded that exists an important collateral communication between the cremasteric and deferential vessels at second-stage FS procedure (41).…”

Section: Fowler-stephens Surgerymentioning

confidence: 99%

Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis – a narrative review

et al. 2022

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Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.

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“…Testicular survival after the second-stage FSO procedure is dependent on an adequate arterial supply 10 ; preserving two sources of collateral blood supply (deferential artery and gubernaculum) is associated with better outcomes compared with preserving just one source (deferential artery). 7 In theory, compared with open surgery, laparoscopic surgery may improve testicular survival rates, because it provides better visibility, which aids in the proper dissection of the spermatic cord in the retroperitoneum.…”

Section: Introductionmentioning

confidence: 99%

Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler–Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study

Zhou

Chen

Yin

et al. 2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The benefits of performing open versus laparoscopic gubernaculum-sparing second-stage Fowler–Stephens orchiopexy (FSO) remain unclear. We compared the two techniques to answer this question. Methods: We retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO at our institution between September 2004 and June 2020 (all patients underwent surgery by a single surgeon). We evaluated both procedures based on the incidence of testicular atrophy, testicular ascent, and other complications. Results: The age at initial surgery was 45.7 ± 28.2 months (median, 39). One hundred nine cases were treated with open second-stage gubernaculum-sparing FSO (OFSO), and 96 cases were treated with laparoscopic second-stage gubernaculum-sparing FSO (LFSO). The mean follow-up period was 59.8 months (median, 54; standard deviation, +35). The overall testicular atrophy rate was 1.5%. Atrophy was observed in 2 and 1 patient in the OFSO and LFSO groups, respectively (1.8% versus 1.0%, P > .05). There was no significant difference in the incidence of testicular ascent between both groups (2.8% versus 3.1%). Five and four complications were noted in the OFSO and LFSO groups, respectively ( P > .05). Conclusions: Second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions. Neither the open nor laparoscopic approach appeared superior, because the overall testicular survival rates and incidence of testicular ascent and other complications were equivalent between both groups.

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Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler–Stephens procedure

Abstract: These images confirm the presence of robust collateral between the cremasteric and deferential vessels at second-stage FS procedure. Preservation of these collaterals in a gubernaculum-sparing approach may explain the excellent results seen in this series.

Cited by 13 publications

References 7 publications

The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes

The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes

Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis – a narrative review

Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler–Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study

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