OBJECTIVE:
To assess the outcome of laparoscopic orchiopexy and the two-stage Fowler Stephens technique for managing patients with impalpable testis in terms of safety, feasibility and efficacy.
PATIENTS AND METHODS:
This study included 78 patients who presented with 88 non-palpable testes to the outpatient clinic of Sohag university hospital in 2005-2009, and underwent laparoscopy by the same surgeon. Intra-abdominal testes were managed by laparoscopic orchiopexy if low, two-stage Fowler-Stephens technique if high, and orchiectomy if atrophic. Children were evaluated postoperatively to check the location and size of the testicle and to exclude any other complication.
RESULTS:
Median age at presentation was 16 months (range 11-42 months). Four testes were absent while inguinal exploration was necessary for six testes with the vas entering the internal ring. Of the 78 intra-abdominal testes, 45 were identified as high (Fowler-Stephens in 43; orchiectomy in two atrophic testes) and 33 as low (orchiopexy). Follow up was 3-55 months (mean 34 months). Twelve patients (12 testes) were lost to follow up (7 Fowler-Stephens; 5 orchiopexy). On follow up, the testes were normal sized and well positioned in the scrotum in 28/28 and 32/36 testes in the orchiopexy and Fowler-Stephens groups with an overall success rate of 100% and 88.8%, respectively. Two testes showed testicular displacement and two showed testicular atrophy in patients of the Fowler-Stephens group.
CONCLUSION:
Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with non-palpable testes, with excellent outcomes.