PEDIATRIC UROLOGY

Long-term outcome of laparoscopic Fowler-Stephens orchiopexy in boys with intra-abdominal testis
Esposito C, Vallone G, Savanelli A, Settimi A
Department of Pediatrics, “Federico II” University of Naples, Naples, Italy
J Urol. 2009; 181: 1851-6

• Purpose: 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.
• Materials and Methods: 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.
• Results: 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.
• Conclusions: 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.
  
  
• Editorial Comment
  The authors reviewed laparoscopic Fowler-Stephens orchiopexy results for a total of 36 patients in their series with 10-17 years of follow up. 33 of the patients had 1st and 2nd stage Fowler-Stephens procedures done laparoscopically. 13 of the 25 available patients refused clinical follow up reporting a viable testis in the scrotum. 12 patients agreed to follow up. 2 had atrophic testicles and 10 had testicles in the scrotum, 7 in the lower scrotum and 3 in the upper median part of the scrotum. Ultrasound showed bilateral microcalcifications in both testicles of 1 patient with normal tumor markers. Each of the operated on testicles showed good blood flow in the scrotum, however the operated on testicle was always smaller than the contralateral testicle.
  It is interesting that 83.3% of the patients had viable testes greater than 10 years after staged laparoscopic Fowler-Stephens orchiopexies. It is disappointing that semen analyses were not available on these patients and history of fertility was not available due to the age of the patients. It is rewarding to note that Fowler-Stephens orchiopexies have good results and good long-term outcomes and the procedure should be considered with enthusiasm.

Dr. Brent W. Snow
Division of Urology
University of Utah Health Sci Ctr
Salt Lake City, Utah, USA
E-mail: brent.snow@hsc.utah.edu