Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction?

Infographic · Jun 2024 · 2 min read

In brief

Multicenter comparative study of 147 intra-abdominal testes treated with either traditional Fowler-Stephens orchiopexy (vessel division) or newer Shehata technique (vessel traction). Both approaches achieved similar scrotal positioning (81-85%) and atrophy rates (10-13%), but Shehata preserves testicular vascularization with shorter interval between stages.

Spermatic vessel traction (Shehata) achieves 85% scrotal positioning vs 81% with Fowler-Stephens, with comparable 10-13% atrophy rates.
Traction technique allows shorter interval between stages (2.3 vs 6.1 months) and preserves testicular vascularization.
21% of traction cases had collapsed vessels but only 1.3% required redo, suggesting technical feasibility despite initial concerns.
Both techniques show equivalent long-term outcomes; vessel preservation may benefit future spermatogenesis (requires post-pubertal data).
Multicenter data (147 testes) supports traction as valid alternative to standard Fowler-Stephens for intra-abdominal testis management.

Written by the GCMD Library team from the infographic.

The infographic uses a left-to-right flow diagram with anatomical illustrations of the male reproductive system. Two surgical pathways are shown in blue (Fowler-Stephens) and gray (Shehata), converging to a second-stage orquidopexy procedure. On the right, outcome metrics are displayed with checkmark and X icons showing testicular position and atrophy rates. The color scheme uses red for the study details banner on the left, blue for emphasis on the Fowler-Stephens pathway, and institutional branding at the bottom.

New infographic by Dr. Jose Campos & the Chilean Society of Pediatric Surgeons,

"Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study"

Authors: Valeska Bidault-Jourdainne, Nathalie Botto, Matthieu Peycelon, Elisabeth Carricaburu, Pauline Lopez, Arnaud Bonnard, Thomas Blanc 6, Alaa El-Ghoneimi, Annabel Paye-Jaouen

Full article: https://pubmed.ncbi.nlm.nih.gov/38310033/

Abstract

Background: Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques.

Objective: To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS).

Study design: Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared.

Results: A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques.

Discussion: Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view.

Conclusions: This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.

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