Efficacy of single-stage and two-stage Fowler–Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis

摘要

Summary Background/Objective To compare the curative effect of single-stage and two-stage Fowler–Stephens (F–S) laparoscopic orchidopexy for intraabdominal high testis and explore the appropriate surgical approach. Methods We performed a prospective analysis of the clinical data of 28 patients who underwent F-S laparoscopic orchidopexy for intraabdominal high testis in our department from May 2012 to April 2015, including 15 cases of the single-stage F-S operation and 13 cases of the two-stage F-S operation. By comparing the two groups preoperative and postoperative (6 months) clinical data of testicular position, testicular volume, and sex hormone levels [testosterone (T), follicle stimulating hormone (FSH), and estradiol (E 2 )], we analyzed the difference in efficacy between the two procedures. Results Twenty-eight patients completed laparoscopic surgery, no case was converted, and no testis was excised. All patients were followed up for 9–25 months after the operation, with an average follow-up of 16.2 months. The postoperative testicular volume of the single-stage and two-stage F-S groups was not significantly reduced ( p >0.05). In both groups, the postoperative T levels were significantly increased compared to the preoperative levels ( p <0.05), while the FSH and E 2 levels were significantly decreased ( p <0.05). The differences in testicular volume and T, FSH, and E 2 levels between the two surgical procedures were not significant ( p >0.05). In the single-stage F-S group, the testes were located in the scrotum in 13 cases and retracted to the lower groin in two cases. In the two-stage F-S group, the testes were located in the scrotum in 12 cases and retracted to the lower groin in one case. The difference in postoperative testicular position between the two groups was not significant ( p >0.05). Conclusion In the case of testis with good collateral circulation, single-stage F-S laparoscopic orchidopexy had the same safety and efficacy as the two-stage F-S procedure. Surgical options should be based on comprehensive consideration of intraoperative testicular location, testicular ischemia test, and collateral circumstances surrounding the testes. Under the appropriate conditions, we propose single-stage F-S laparoscopic orchidopexy be preferred. It may be appropriate to avoid unnecessary application of the two-stage procedure that has a higher cost and causes more pain for patients.