Portal de Periódicos da CAPES

Open Versus Laparoscopic Staged Fowler-Stephens Orchiopexy: Impact of Long Loop Vas

2009; Lippincott Williams & Wilkins; Volume: 182; Issue: 5 Linguagem: Inglês

10.1016/j.juro.2009.07.050

1527-3792

Sumit Davé, Numchai Manaboriboon, Luis H. Braga, Armando J. Lorenzo, Walid A. Farhat, Darius Bägli, Antoine E. Khoury, João L. Pippi Salle,

Assisted Reproductive Technology and Twin Pregnancy

There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy.Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12). The presence of a long looping vas was noted from the first stage operative notes. Doppler ultrasound was performed postoperatively to confirm testicular atrophy.Atrophy rate at a mean followup of 13.5 months was 20.5% (15 of 61 in laparoscopic and 0 of 12 in open orchiopexy). None of the 5 long looping vas testes atrophied following open orchiopexy, compared to 5 of 6 (83%) following laparoscopic orchiopexy (p = 0.03). Analyzing the laparoscopic group alone, a long looping vas was significantly associated with risk of atrophy (p <0.01).The presence of a long looping vas was associated with a higher atrophy rate following laparoscopic second stage Fowler-Stephens orchiopexy. Laparoscopic management of the long looping vas may be more challenging and, therefore, in such cases open Fowler-Stephens orchiopexy may result in better success rates by preserving the integrity of the collateral vessels.