Treatment of High Undescended Testes by Low Spermatic Vessel Ligation: An Alternative to the Fowler-Stephens Technique

Abstract

Purpose We determined whether testis viability after a Fowler-Stephens orchiopexy depends on ligating the spermatic vessels high and far proximal to the undescended testis. Materials and Methods Based on studies of testicular vascular anatomy we developed a technique of low spermatic vessel ligation and performed it on 39 high undescended testes in 33 patients. Results Testis viability was 97 percent at 1 month and 93 percent (25 of 27) at 1 year. Conclusions Ligation of the spermatic vessels does not need to be performed high to ensure testis viability. Testicular vascular anatomy supports low spermatic vessel ligation and by decreasing tension on the testis low spermatic vessel ligation may enhance viability. A 2-stage laparoscopic approach to the high undescended testis is difficult to justify on the basis of cost or outcome analysis.