Comparative evaluation of the results of two-stage abdominal testicle reduction by Fowler–Stephens and a one-stage method with preservation of testicular vessels

Abstract

BACKGROUND: Normal testicular function is only possible if it is located in the scrotum; if the testicle is undescended, fertility decreases and the risk of malignancy increases.
 AIM: Aim of the study is to compare the results of a one-stage bringing down of the abdominal testicle with preservation of the testicular vessels and a two-stage Fowler–Stephens operation regarding the risk of atrophy of the reduced gonad.
 MATERIALS AND METHODS: A total of 241 patients with a non-palpable testicle in the scrotum were observed, of which 125 (51.87%) patients the testicles were brought down with laparoscopic assistance. Three groups of patients were identified. The first group consisted of 105 (84%) patients who underwent testicular bringing down in two stages using the Fowler–Stephens technique with an interval of at least 6 months. The second group consisted of 20 (16%) patients whose underwent laparoscopic bringing down in one stage with preservation of the testicular vessels. The main criterion for effectiveness was the size of the gonad 6 months after surgery according to ultrasound. The third group included 116 (48.13%) patients with absent testicle.
 RESULTS: In the first group the average duration of the first stage of the operation was 19.07 [10; 65] minutes, second stage 48.59 [20; 160] minutes. A total of 117 testicles were brought down to the scrotum. 77 (65.81%) hypoplastic gonads were identified, of which in 6 (5.13%) cases the volume of the testicle increased after the first stage of the operation, 8 (6.84%) gonads decreased in volume and 1 (0.85%) testicle atrophied after completing the second stage. In 62 (52.30%) testicles the size did not change between the stages of the operation. Subsequently, these gonads remained hypoplastic. In 40 (34.19%) gonads there was no decrease in volume, but between the stages of intervention, an increase in the volume of the organ was noted in 3 (2.56%) cases, in 7 (5.98%) cases a decrease in the volume of the gonads, in 29 (24.79%) of patients, the size of the testicles did not change between the stages of the operation, 1 (0.85%) of the gonad atrophied after the second stage of the operation. In the second group the average duration of the operation was 42.59 [20; 100] minutes. A total of 22 gonads were brought down, of which 6 (27.27%) testicles were not hypoplastic and did not decrease in size after being brought down into the scrotum, 16 (72.73%) — were initially hypoplastic. Of these, 1 (4.55%) gonad increased in volume, 1 (4.55%) — decreased, 14 (63.64%) — remained unchanged after surgery. There was no testicular atrophy after descent. In patients of the third group, in 40 (34.48%) cases, the vessels ended blindly in the abdominal cavity. In 3 (2.59%) boys, testicular buds located in the abdominal cavity were removed. The vessels of the testicle went into the inguinal canal in 73 (62.93%) cases, of which in 34 (29.31%) — the vessels ended blindly and 39 (33.62%) testicular rudiments were found, which were removed.
 CONCLUSIONS: Bringing down of the testicle with preservation of its own vessels is more preferable compared to a two-stage operation due to the absence of the need for a second intervention on the gonad, a greater degree of preservation of testicular volume after its brought down and, in our case, the absence of gonadal atrophy after its descending.