Correction to “Bilateral High Intra‐Abdominal Testes Successfully Treated With Multistage Fowler–Stephens Orchiopexy to Preserve Testicular Function”

Spermatogenesis After 1-Stage Fowler-Stephens Orchiopexy in Experimental Cryptorchid Rat Model

ABSTRACTIntroductionA case of bilateral high intra‐abdominal testes successfully treated with multistage Fowler–Stephens orchiopexy is reported.Case PresentationA 6‐month‐old boy with bilateral nonpalpable testes was diagnosed with a left intra‐abdominal testis located immediately caudal to the spleen on magnetic resonance imaging and laparoscopy. At the age of 4 years, diffusion‐weighted magnetic resonance imaging detected a structure immediately caudal to the liver, which was suspected to be the right testis. With a diagnosis of bilateral intra‐abdominal testes, one‐stage Fowler–Stephens orchiopexy was performed on the right testis at 5 years of age. After confirming its development, two‐stage Fowler–Stephens orchiopexy was performed on the left testis at 10 years of age.ConclusionAfter confirming the development of the right testis that underwent one‐stage Fowler–Stephens orchiopexy, two‐stage Fowler–Stephens orchiopexy was completed on the left testis, resulting in the successful preservation of both testes and normal sexual development.

Two-Stage Fowler-Stephens Orchiopexy in the Management of Intra-Abdominal Testes

BackgroundSeveral recent reports have demonstrated that the preoperative sensitivity and accuracy of identifying and locating non-palpable testes increases with the use of conventional MRI, in addition to diffusion-weighted imaging (DWI). Therefore, pre-operative prediction of the presence and location of testes using imaging techniques may guide management of intra-abdominal testis. Fowler-Stephens orchiopexy is effective for treating patients with intra-abdominal testis; however, long-term testicular function after this procedure has not been clarified. We present a case of a high intra-abdominal testis located below the kidney, and discuss the usefulness of fusion view with T2-weighted and DWI images to make a diagnosis of high intra-abdominal testis and the pathological findings to predict future fertility potential.Case presentationA 10-month-old boy was referred to the urology department for the management of non-palpable testis. We employed not only conventional MRI, but also DWI, to improve the diagnostic accuracy of non-palpable testes by MRI examination. The high-intensity mass-like structure below the kidney on the T2-weighted image and the markedly high signal intensity mass on the DWI image completely matched, which suggested that the mass below the kidney was the right testis. The patient underwent diagnostic and therapeutic laparoscopy. A testis was found under the ascending colon, 1 cm below the right kidney. We performed 2-stage Fowler-Stephens orchiopexy. The testis could be delivered to the scrotum without any tension. We examined expression patterns of the stem cell marker, undifferentiated embryonic cell transcription factor 1 (UTF1) in the testicular biopsy sample, and demonstrated that the UTF1-positive Ad spermatogonia / negative Ad spermatogonia ratio was lower in this patient than in boys his age with descended and inguinal undescended testes, indicating that spermatogonial stem cell activity may decrease remarkably in this boy.ConclusionsFusion view with T2-weighted and DWI images may be a useful diagnostic modality for high intra-abdominal testes. Fowler-Stephens orchiopexy may provide blood supply to the testis but that might not be enough to achieve spermatogenesis.

Treatment of the undescended testicle (UT) after it failed to descend on hormonal therapy is surgical. Spermatic cord elongation may impair testicular function, particularly in cases in which cord integuments or veins have to be divided to provide an extra cord length. A factor that might impede testicular descent is presence of a narrowed or obliterated inguinal canal. We investigated the hypothesis that dilatation of a narrowed or obliterated inguinal canal might assist spontaneous testicular descent. Twenty-six boys (age 3.6 +/- 0.8 years) with unilateral UT and failed hormonal treatment, whose UT was located at deep inguinal ring, were included in the study. Through an inguinal incision, the inguinal canal was dilated, spermatic cord adhesions divided, hernial sac, if present, excised, and skin closed. Testicular descent into the scrotum occurred in 22 patients within 4.2 +/- 1.3 months. The remaining four patients were reoperated on by Fowler-Stephens orchiopexy after 14 months. A technique is presented for the treatment of the UT after failure to respond to hormonal treatment. It consisted of clearing the testicular pathway of any adhesions and dilating the narrowed inguinal canal. The technique is simple, easy, and does not interfere with the testicle or spermatic cord.

Effects of the Fowler-Stephens orchiopexy on testicular structure and function