SUCCESSFUL OUTPATIENT MANAGEMENT OF THE NONPALPABLE INTRA-ABDOMINAL TESTIS WITH STAGED FOWLER-STEPHENS ORCHIOPEXY

Abstract

Previous reports of orchiopexies have shown an 85.9% success rate for staged Fowler-Stephens orchiopexy (FSO). We review our experience with nonpalpable testes (NPTs). A total of 119 patients with 128 NPTs were treated at our institution between 1994 and 2001. Atrophic testes or "nubbins" were removed. Once an intra-abdominal testis was identified the peritoneum was opened and firm traction was placed on the gonad. If feasible, primary orchiopexy was completed. Otherwise, staged Fowler-Stephens orchiopexy was performed. Primary orchiopexy was performed in 28 testes in 27 patients without division of the spermatic vessels. An atrophic nubbin was removed in 45 patients. All children with bilateral NPTs had at least 1 viable intra-abdominal testis found at surgery. Staged FSO was performed in 55 testes in 47 children. The second stage was performed at a median of 3.5 months after initial ligation of the spermatic vessels. Median followup was 1 year and mean followup was 9 months. Five patients were lost to followup. Successful surgery was defined as a dependent scrotal location and testis size equivalent to the contralateral mate. The overall success rate for the primary orchiopexy group was 100%. In the staged FSO group 1 patient had an atrophic testis at 1-year followup, yielding an overall success rate of 98%. A high degree of success can be obtained for children with intra-abdominal testes. Mobility of the testis on exploration is a good indicator that the testis can be managed with primary orchiopexy without division of the vessels. If primary orchiopexy cannot be performed, excellent results are achieved with a staged FSO.