Open versus laparoscopic staged Fowler-Stephens orchiopexy: impact of long loop vas.
OBJECTIVE
There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy.


METHODS
Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12). The presence of a long looping vas was noted from the first stage operative notes. Doppler ultrasound was performed postoperatively to confirm testicular atrophy.


RESULTS
Atrophy rate at a mean followup of 13.5 months was 20.5% (15 of 61 in laparoscopic and 0 of 12 in open orchiopexy). None of the 5 long looping vas testes atrophied following open orchiopexy, compared to 5 of 6 (83%) following laparoscopic orchiopexy (p = 0.03). Analyzing the laparoscopic group alone, a long looping vas was significantly associated with risk of atrophy (p <0.01).


CONCLUSIONS
The presence of a long looping vas was associated with a higher atrophy rate following laparoscopic second stage Fowler-Stephens orchiopexy. Laparoscopic management of the long looping vas may be more challenging and, therefore, in such cases open Fowler-Stephens orchiopexy may result in better success rates by preserving the integrity of the collateral vessels.
Dave
Sumit
S
Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Manaboriboon
Numchai
N
Braga
Luis H P
LH
Lorenzo
Armando J
AJ
Farhat
Walid A
WA
Bägli
Darius J
DJ
Khoury
Antoine E
AE
Salle
Joao L Pippi
JL
D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014649:Vas Deferens