Laparoscopic-guided second-stage Fowler-Stephens procedure for nonpalpable testis in children

Laparoscopy has become the standard approach in the treatment of nonpalpable testis in children. Usually, in the two-stage operation, the laparoscope is used for locating and dividing the spermatic vessels in the first stage. In the second stage, the divided abdominal testis is brought into the scrotum through an inguinal incision. We found that a laparoscopically guided second stage can significantly simplify the detection and final treatment of the abdominal testis. In the last 24 months, we performed laparoscopies on 30 children with nonpalpable testis. Twelve of them were found to have normal size intra-abdominal testis and underwent the Fowler-Stephens procedure. Ten children in this group (83%) were found to have a normal size scrotal testis, following the second and final stage of this procedure. Our contribution is the introduction of laparoscopy as part of the protocol of the second-stage Fowler-Stephens procedure, in which the laparoscopic findings will determine the subsequent operative steps. Laparoscopic orchiectomy will be performed for the atropic testis (20% in most series), and a laparoscopically assisted orchiopexy, for normal size intraabdominal testis, the majority of our cases. We conclude that laparoscopy is a safe and reliable procedure, which allows accurate diagnosis and may prevent unnecessary explorations in children with anorchia. We strongly suggest laparoscopy for the management of nonpalpable testis in childhood in both, first- and second-stage Fowler-Stephens procedures, based on our good results using this policy over the past 2 years.