Successful Outpatient Management of the Nonpalpable Intra-Abdominal Testis With Staged Fowler-Stephens Orchiopexy

Dhanani, Nadeem N.; Cornelius, Dena; Güneş, Ali; Ritchey, Michael L.

doi:10.1097/01.ju.0000140989.49309.1e

Cited by 34 publications

(12 citation statements)

References 16 publications

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“…Although in their original study, Dhannani et al [11] reported a meaningful success rate (98%) by performing a two stage FSO; we believe that our results with single stage procedure may be accepted as comparable with this study.…”

Section: Discussionsupporting

confidence: 84%

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

et al. 2006

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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.

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Section: Discussionsupporting

confidence: 84%

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

et al. 2006

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“…Four studies were judged good quality, 27,45,49,52 1 fair quality, 32 and the remainder poor quality. [28][29][30][31][33][34][35][36][37][38][39][40][42][43][44][46][47][48]50,51,53 Eleven studies reported outcomes after either 1-stage FS orchiopexy, 2-stage FS orchiopexy, or primary orchiopexy. [36][37][38][39][40][42][43][44][45]47,48 Nine of these studies, all retrospective cohorts, provided success rates by surgical procedure, although the choice of surgical method is made clinically and not with the intent of comparative effectiveness.…”

Section: Effectiveness Of Surgical Proceduresmentioning

confidence: 99%

Effectiveness of Hormonal and Surgical Therapies for Cryptorchidism: A Systematic Review

Penson¹,

Krishnaswami²,

Jules

et al. 2013

Pediatrics

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BACKGROUND AND OBJECTIVE: Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism. METHODS: We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria. RESULTS: Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare. CONCLUSIONS: The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Daher

Nabbout

Feghali

et al. 2009

Journal of Pediatric Surgery

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Successful Outpatient Management of the Nonpalpable Intra-Abdominal Testis With Staged Fowler-Stephens Orchiopexy

Cited by 34 publications

References 16 publications

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

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

Effectiveness of Hormonal and Surgical Therapies for Cryptorchidism: A Systematic Review

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

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