2-STAGE FOWLER-STEPHENS-ORCHIOPEXY WITH LAPAROSCOPIC CLIPPING OF THE SPERMATIC VESSELS

Purpose: We report the outcome of a staged approach to the intra-abdom inal testicle and provide baseline data on operative time, postoperati ve course and testicular survival. Materials and Methods: We retrospec tively reviewed the records of 441 boys (547 undescended testes). Ther e were 105 boys (24%) with 124 nonpalpable testes (23%). All patients underwent laparoscopy. Ligation of spermatic vessels was performed as stage 1 on 20 abdominal testes (4%) in 18 boys (4%). Stage 2 orchiopex y was done using an open technique. Results: Two-stage orchiopexy in 1 8 boys included a bilateral procedure in 2, of which 1 was asynchronou s and 1 was synchronous. Average operative time was 55 minutes for sta ge 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were perform ed on an outpatient basis in 18 and 17 (94%) boys, respectively. There were no complications after stage 1 and 1 wound infection developed a fter stage 2. One testis with no vas deferens was determined to be non viable at stage 2. The remaining 19 testes (95%) were considered viabl e at a followup of 6 months or greater. Viability was based on testicu lar size and consistency similar to those of the contralateral testis. Conclusions: Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach pro vides adequate viability of the intra-abdominal testis.