Long-Term Outcome of Laparoscopic Fowler-Stephens Orchiopexy in Boys With Intra-Abdominal Testis

Abstract

We reviewed the records of 36 pediatric patients operated on between 1990 and 1997 for high intra-abdominal testes, using the 2-step Fowler-Stephens procedure via laparoscopy. Patients were followed for 10 to 17 years. Three patients who had undergone the second stage by open procedure were excluded from study. The 33 remaining patients were contacted by telephone, and 12 (7 with right and 5 with left intra-abdominal testes) agreed to undergo clinical and instrumental examination. Patient age ranged from 13 to 26 years (average 14.7). All patients underwent clinical examination and volumetric measurement of both testes using color Doppler ultrasound. Two of the 12 patients (16.7%) had an atrophic testis in the scrotum and 10 (83.3%) had a viable testis in the scrotum. The operated testis was always smaller than the normal testis, despite the good vascularization detected on echo color Doppler ultrasound. One patient had ultrasound evidence of bilateral microcalcifications with normal vascularization. Mann-Whitney test showed there was a statistically significant difference between the volume of the operated testis and the normal testis. It is extremely difficult to perform studies on the long-term outcome of surgical procedures. We describe the outcome at more than 10 years postoperatively, and demonstrate that greater than 83% of patients who underwent a 2-step Fowler-Stephens procedure using laparoscopy had satisfactory results. The operated testis was always significantly smaller compared to the normal testis but was well vascularized.