Laparoscopic Diagnosis And Treatment Of Non-palpable Testis

Main Category: Urology / Nephrology
Article Date: 28 Sep 2008 - 0:00 PDT

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UroToday.com - This study by Dr. Francisco T. Denes and colleagues from Sao Paulo, Brazil evaluated the group's laparoscopic technique - a useful alternative approach for impalpable testes.

They presented their data for 90 patients who underwent laparoscopy for impalpable testes. Over 50% of the patients (46) had an intraabdominal testis identified. Nineteen patients underwent a two stage laparoscopic Fowler-Stephens orchiopexy for 25 testes. The other 27 patients underwent primary laparoscopic orchiopexy for 29 impalpable testes.

In their group, the overall success rate with the two stage Fowler-Stephens approach was 88%, with only a 33% success rate with the one stage Fowler-Stephens orchiopexy with primary vascular ligature. The group found no intra-operative complications. Subjectively they thought that the laparoscopic cosmetic appearance was remarkably more favorable as compared to open surgeries, but this was not quantified in any manner with quality of life questionnaires.

They felt that the laparoscopic approach in the pediatric group was safe and feasible. They recommend that a two stage Fowler-Stephens is more successful than a one stage Fowler-Stephens.

With further advancements in laparoscopic procedures, it has been my experience that dissecting the vessels back to their origin would negate the majority of Fowler-Stephens staged and unstaged orchiopexies. At this time, and in our experience, it has been extremely rare to perform a Fowler-Stephens orchiopexy once we dissect the vessels, when needed, back to their origins.

Denes FT, Saito FJ, Silva FA, Giron AM, Machado M, Srougi M
Int Braz J Urol. 2008 May-Jun;34(3):329-35

Written by UroToday.com Medical Editor Pasquale Casale, MD

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