Single stage Fowler–Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes

Abstract

In this present study we aimed to discuss the surgical efficacy of single stage Fowler-Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.

Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis?

“…It involves clipping and transecting the testicular vessels and then mobilizing the testis in which vascularization will become dependent on collateral deferential (vasal) artery [16,17]. The success rate of the one-step Fowler-Stephens procedure is between 67% and 100% [10,[17][18][19], but most studies report good results in less than 85% of patients [2,20]. Although some surgeons prefer a 2-step Fowler-Stephens procedure, the disadvantage is that during the second stage the reproductive tract (including the vas deferens and epididymis), as well as the testicular blood supply, might be injured [4].…”

Long-term follow-up results of testicular torsion in children

“…The first TA evidence appeared on Doppler ultrasound at least 3–4 months after orchiopexy for cryptorchidism. 19 We also examined the TVL changes with time after surgery. According to our analysis, most atrophied testes appeared within 3–6 months after surgery, although some atrophied testes appeared just 1 month or 2 months after torsion ( Figure 2a ).…”

Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center

“…Despite the fact that cryptorchidism is a common disease in pediatric surgery, the treatment of high IAT is still a great challenge for the majority of urologists (16). Many scholars attempt to solve this problem through various methods, but so far there is no consensus (17)(18)(19).…”