PEDIATRIC SURGERY UPDATE ©

VOLUME 49 NO 04 OCTOBER 2017

Fowler-Stephen Orchidopexy

Undescended testis (UT) is the most common congenital anomaly of the genitalia of newborn males. It is more common in prematurely born infants. It is estimated that 20% of undescended testis are non-palpable. Non-palpable UT might be intraabdominal, canalicular, atrophic or absent. Orchidopexy in UT should be performed before the age of 18 months to avoid damage to spermatogonia. Diagnostic laparoscopy is the gold standard maneuver to determine localization and eventual management of non-palpable UT. Laparoscopy is better than CT-Scan, MRI, gonadal arteriography or venography in localizing the presence, distance and size of a nonpalpable UT. Blind ending vessels without a distal testis determine absence and no further management is required. If vessels and vas enter the internal spermatic ring, the child probably has a canalicular testis or nubbin in either case it should be moved and fixed to the scrotum or removed respectively suing an inguinal incision. Atrophic or hypoplastic testes are removed during the diagnostic procedure. Intraabdominal testes are either brought down to the scrotum and fixed if the vascular pedicle permits such maneuvers (laparoscopic assisted orchidopexy) or staged its descent using Fowler-Stephen technique (FST). Two-stage FST is performed if the testis is at a high position estimated as more than 2 centimeters between the manipulated testis and the internal ring. The technique consists of clamping and dividing the vascular supply to the testis and leaving it alone so that collateral blood supply develops from the vas deferens. FST can be performed one or two staged procedure. The one-stage FST preserved the gubernaculum for additional collateral blood supply. In the second stage of FST orchidopexy is performed six months later descending the testis with vas deferens-based circulation by fixing it to the scrotum using laparoscopy and inguinal surgery. Success rate for one stage FST can approach 70% which are encouraging. The most common complication after performing either FST is testicular atrophy. 

References:
1- Elder JS: Surgical Management of the Undescended Testis: Recent Advances and Controversies. Eur J Pediatr Surg. 26(5):418-426, 2016
2- Hamidi N, Telli O, Bagci U, Esen B, Karagoz MA, Hascicek AM, Soygur T, Burgu B: Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes. Front Pediatr. 2016 Mar 4;4:13. doi: 10.3389/fped.2016.00013. eCollection 2016.
3- Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A: Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg. 51(2):211-5, 2016
4- Nayci A, Bahadir GB, Erdogan C, Taskinlar H: Laparoscopic one-stage Fowler-Stephens orchiopexy preserving gubernaculum. Turk J Urol. 43(1):75-78, 2017
5- Wang CY, Wang Y, Chen XH, Wei XY, Chen F, Zhong M: Efficacy of single-stage and two-stage Fowler-Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis. Asian J Surg. Apr 12. pii: S1015-9584(16)30154-3. doi:10.1016/j.asjsur.2016.11.008, 2017
6- Alam A, Delto JC, Blachman-Braun R, Wayne G, Mittal AG, Castellan M, Kozakowski K, Labbie A, Gosalbez R: Staged Fowler-Stephens and Single-stage Laparoscopic Orchiopexy for Intra-abdominal Testes: Is There a Difference? A Single Institution Experience. Urology. 101:104-110, 2017

         Icteropyloric Syndrome

*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
P.O. Box 10426, Caparra Heights Station, San Juan, Puerto Rico 00922-0426
Tel (787)-999-9450 Fax (787)-720-6103 E-mail: TITOLUGO@COQUI.NET
Internet Address:HTTP://HOME.COQUI.NET/TITOLUGO
® Copyright Office of the Library of Congress 1997


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Pediatric Surgery Update ISSN 1089-7739
Last updated: November 2017