PEDIATRIC UROLOGY

Long-term outcome of Fowler-Stephens orchiopexy in boys with prune-belly syndrome
Patil KK, Duffy PG, Woodhouse CR, Ransley PG
Department of Paediatric Urology, Great Ormond Street Hospital for Children, London, United Kingdom
J Urol. 2004; 171: 1666-9

• Purpose: Intra-abdominal testes in boys with prune-belly syndrome have been conventionally managed by 1 or 2-stage orchiopexy with division of the gonadal vessels. We reviewed a series of adults with prune-belly syndrome to assess the morphological and functional outcome of orchiopexy in childhood with specific reference to the spontaneous onset of puberty, hormonal profiles and sexual function.
• Materials and Methods: A total of 41 boys were divided into 3 groups depending on the type of orchiopexy performed, namely group 1 - 20 with bilateral 1-stage orchiopexy, group 2 - 10 with unilateral 1-stage and contralateral 2-stage orchiopexy, and group 3 - 11 with bilateral 2-stage orchiopexy.
• Results: In group 1, 9 of 20 patients had good scrotal testes bilaterally, 6 had a good scrotal testis on 1 side and 3 had small testes on each side. Two boys required testosterone supplementation but 18 had normal hormonal and sexual function. In group 2 6 of 10 patients had good scrotal testes bilaterally and 4 had a good scrotal testis on 1 side. All patients underwent spontaneous puberty with good sexual function. In group 3, 7 of 11 boys had good scrotal testes bilaterally and 3 had 1 good testis with normal puberty and sexual function. These 10 patients underwent spontaneous puberty with good sexual function.
• Conclusions: The majority of boys with prune-belly syndrome had a satisfactory outcome after orchiopexy with division of the gonadal vessels with testicular function sufficient to induce puberty and maintain satisfactory sexual function in adult life.
  
  
• Editorial Comment
  In pediatric urology, many papers on long-term follow-up are based on observations made over several years. This paper is highly significant in that it assesses outcome on average 17 years after surgery. Early outcomes orchiopexy in the prune belly syndrome have been thought to be good, particularly when the operation has been done at an early age. However, this series provides another, more important view. Over time, particularly past the age of puberty, accurate assessment of testicular growth and function is more possible. In this series, of patients undergoing Fowler-Stephens orchiopexy in expert hands, only 22 of 41 patients had morphologically normal testes bilaterally. There was a slightly higher rate of success in those who underwent a bilateral two-stage Fowler-Stephens orchiopexy (7/11), but even this is not as positive as most surgeons would like. Fortunately, only 2 patients in the series require testosterone replacement and the rest underwent spontaneous puberty and reported good sexual function. The authors are to be congratulated on an important “long-term” follow-up.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA