Letter to editor: Two-stage Fowler-Stephens orchidopexy in management of undescended testes: Is it time for a change? A UK multi-centre retrospective study

jpedsurg.org

I thank the authors for their honest reporting of the outcomes of two stage Fowler Stephen (FS) orchidopexy for intraabdominal testis across six UK paediatric surgical centres. They report a sobering 22 % atrophy rate. This was despite a generous definition of atrophy as either a nubbin or no palpable testis on post operative follow up. Though they have not explicitly mentioned so in the paper, it is assumed that the first stage involved division of the vessels and the second stage involved division of the gubernaculum, therefore basing the blood supply of the testis only on the artery of the vas.

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Article · Sep 2025 · 1 min read

In brief

This letter responds to a UK multi-centre study examining two-stage Fowler-Stephens orchidopexy outcomes for intraabdominal testes, highlighting a concerning 22% testicular atrophy rate. The procedure involves staged division of testicular vessels and gubernaculum, relying solely on vasal artery blood supply, prompting discussion about current surgical approaches.

Two-stage Fowler-Stephens orchidopexy for intra-abdominal testis shows a 22% testicular atrophy rate across UK centres.
Atrophy definition included testicular nubbin or non-palpable testis on postoperative follow-up.
Procedure relies solely on vasal artery blood supply after dividing gonadal vessels in stage one.
High atrophy rates question whether current two-stage approach remains optimal for intra-abdominal undescended testes.

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