To compare single stage laparoscopic orchiopexy (SSLO) and staged Fowler-Stephens (SFS) procedures in the management of intra-abdominal undescended testes, and analyze post-operative atrophy and mal-positioning as endpoints.
A retrospective chart review identified laparoscopic orchiopexy patients with intra-abdominal testes between November 2006 and November 2014. Of 167 patients that had laparoscopic orchiopexy, data for 73 patients (85 testes) were identified to have laparoscopic orchiopexy. Baseline characteristics, as well as testicular scrotal position and size at follow-up were recorded. Regression analysis was performed to compare outcomes between patients who underwent SFS and SSLO.
Of the 85 laparoscopic orchiopexies, 35 were SFS and 50 were SSLO. Patient demographics were comparable in both groups. The median age at surgery was 12 months (5-151 months) and the average follow-up was 17.3 months. On follow-up SFS patients had zero recorded cases of abnormally positioned testes post-operatively, while 10 (20.0%) SSLO patients had abnormal position (odds ratio (OR): 0.05, 95% CI 0.01-0.44). Differences in atrophy rates were not significant.
These results suggest that there may be no difference between the two approaches in terms of post-operative atrophy. However, the SFS appears to be more successful in securing a favorable scrotal position. Atrophy does not seem to be associated with other patient factors. Prospective, randomized studies are indicated to further explore outcomes differences between approaches.
Urology. 2016 Nov 11 [Epub ahead of print]
Alireza Alam, Joan C Delto, Ruben Blachman-Braun, George Wayne, Angela G Mittal, Miguel Castellan, Kristin Kozakowski, Andrew Labbie, Rafael Gosalbez
Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA. Electronic address: ., Urology Department, Mount Sinai Medical Center, Miami Beach, FL, USA., Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA., Division of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA; Texas Children's Hospital and Baylor School of Medicine, Department of Pediatric Urology, Houston, TX, USA.