Laparoscopic orchiopexy for non-palpable testes: outcome of two techniques

To assess the outcome of laparoscopic orchiopexy and the two-stage Fowler Stephens technique for managing patients with impalpable testis in terms of safety, feasibility and efficacy.

This study included 78 patients who presented with 88 non-palpable testes to the outpatient clinic of Sohag university hospital in 2005-2009, and underwent laparoscopy by the same surgeon. Intra-abdominal testes were managed by laparoscopic orchiopexy if low, two-stage Fowler-Stephens technique if high, and orchiectomy if atrophic. Children were evaluated postoperatively to check the location and size of the testicle and to exclude any other complication.

Median age at presentation was 16 months (range 11-42 months). Four testes were absent while inguinal exploration was necessary for six testes with the vas entering the internal ring. Of the 78 intra-abdominal testes, 45 were identified as high (Fowler-Stephens in 43; orchiectomy in two atrophic testes) and 33 as low (orchiopexy). Follow up was 3-55 months (mean 34 months). Twelve patients (12 testes) were lost to follow up (7 Fowler-Stephens; 5 orchiopexy). On follow up, the testes were normal sized and well positioned in the scrotum in 28/28 and 32/36 testes in the orchiopexy and Fowler-Stephens groups with an overall success rate of 100% and 88.8%, respectively. Two testes showed testicular displacement and two showed testicular atrophy in patients of the Fowler-Stephens group.

Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with non-palpable testes, with excellent outcomes.