Laparoscopic orchiopexy for high intra abdominal undescended testis, one stage or two stages fowler-stephens orchiopexy; a comparative study

ABSTRACT

Laparoscopic management of the high intra abdominal testis is still a matter of controversy. Laparoscopic Fowler-Stephens orchidopexy [FSO] is performed either by one stage [laparoscopic clipping and division of the spermatic vessel and proceed for orchiopexy at the same time] or by two stages FSO [laparoscopic clipping and division of the spermatic vessel only and performing laparoscopic release of the testis along with orchiopexy 3-6 months later]. To study the outcome of Laparoscopic one stage and two stages FSO for the management of high intra abdominal testes. A prospective comparative clinical Study included 25 patients [21 unilateral and 4 bilateral non palpable abdominal testes, 29 testes in total] and laparoscopic surgical procedures [One stage FSO was done for 18 testicles and Two stages FSO was done for 11 testicles] were performed at the urology department, Medical city complex, Iraq, during the period between December 2010 and March 2013. Their mean age was 3.2 years. The comparative criteria include; Time of surgery, postoperative complications, testicular position, and testicular viability. Testicular Doppler study revealed four atrophied testes of one stage F.S.O. [22.2%], two atrophied testes among two stages FSO group [18%], this difference was statistically non significant. The difference in the proper scrotal position also was not significant. The operative time difference was significant between both groups [86.6 +/- 10.1 min. for one stage vs 122.7 +/- 13.5 min. for two stages FSO]. One-stage FSO avoids repeated anesthesia and the potential for extensive, sometimes tedious, dissection that is occasionally required during re operation, and shorter operative time, making it more optimal than two stages FSO