Gubernaculum Testis and Cremasteric Vessels Preservation During Laparoscopic Orchidopexy for Intra-Abdominal Testis: Effect on Testicular Atrophy Rates

Abstract

PurposeGubernaculum-sparing laparoscopic orchidopexy (GSLO) - which involves anatomical delivery of the testis through the internal inguinal ring (IIR) - has been proposed as an alternative to Conventional Laparoscopic Fowler-Stephens Orchidopexy (CLO) maximizing collateral blood supply and potentially reducing atrophy rates. Herein, we test this hypothesis by comparing the 2 techniques. Materials and MethodsThe primary (dependent) outcome of this study was the rate of testicular atrophy, which was defined as palpation of a nubbin or the inability to palpate a testis (complete atrophy) on postoperative physical examination at 3 and 12 months. Doppler ultrasound was obtained routinely to further confirm the diagnosis of testicular atrophy. The following independent variables were captured: age at surgery, type of procedure (CLO vs. GSLO), surgical approach (single vs. 2-stage), location of IAT (high vs. low), and patency of the IIR ResultsMean and median age at surgery were 25.7±13.3 and 22 months respectively. Laparoscopy was carried-out for NPT, showing: vanishing IAT in 120 (29%), peeping testes in 80 (19%) and IAT in 212 (51%; 104-low and 108-high). A 1-stage procedure was performed in 44(21%) cases and 2-stage in 168 (79%). CLO was undertaken in pts 46 (22%) and GSLO in 166(78%), based on surgeon preference. The overall atrophy rate was 6.6% (14/212). 13 of 46 testes atrophied after CLO vs 1 of 166 following GSLO (28.3% vs 0.6%, p=<0.01). ConclusionsGSLO is a feasible alternative to CLO. Our findings suggest that preservation of additional vascular supply to the testis (cremasteric vessels and deferential artery as opposed.