Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review

Area of Science:

• Pediatric Surgery
• Urology
• Surgical Outcomes

Background:

• The Fowler-Stephens orchiopexy is a surgical technique used to treat high intra-abdominal testes.
• Testicular atrophy is a known complication of this procedure.
• The optimal approach, single-stage versus two-stage, remains debated.

Purpose of the Study:

• To systematically review and determine the comparative success rates of single-stage versus two-stage Fowler-Stephens orchiopexy.
• To assess testicular viability and position as primary outcomes.
• To evaluate the impact of surgical approach (laparoscopic vs. open) on outcomes.

Main Methods:

• Systematic review and meta-analysis of studies involving boys under 18 years.
• Inclusion of reports from electronic databases, clinical trial registries, and gray literature.
• Random effects models were used for meta-analysis, with heterogeneity assessed via forest plot and I² statistic.

Main Results:

• 61 articles were included from 1,807 citations.
• Pooled success rates were 80% for single-stage and 85% for two-stage Fowler-Stephens orchiopexy.
• The two-stage approach showed a significantly higher success rate (OR 2.0, 95% CI 1.1 to 3.9).
• No difference in success rates was observed between laparoscopic and open techniques.
• Fewer complications were reported for the single-stage approach compared to the two-stage procedure.

Conclusions:

• The two-stage Fowler-Stephens orchiopexy demonstrates a higher success rate for testicular viability than the single-stage method.
• Both laparoscopic and open techniques yield similar success rates.
• The current evidence is of low quality, necessitating randomized controlled trials for definitive conclusions.