- Initial inspection
- Inspect pelvis, iliac vessels, and internal ring on both sides
- Look for spermatic vessels and vas deferens entering or exiting the internal ring
- Carefully trace vas deferens and testicular vessels if present
- Scenarios and findings
- If vas and vessels seen exiting the internal ring → testis likely inguinal → proceed to groin exploration
- If vas and vessels end blindly or in a nubbin → likely vanished testis → remove remnant if presen
- If intra-abdominal testis is seen → assess mobility, vascular supply, and distance from scrotum
- Intra-abdominal testis options
- If low-lying and mobile → laparoscopic orchidopexy (single stage)
- If high intra-abdominal and short vessels → consider Fowler-Stephens (single or two-stage)
Fowler-Stephens Procedure
- Indications
- High intra-abdominal testis with insufficient length of spermatic vessels
- Used when single-stage orchidopexy is not feasible
- First Stage: Vascular Isolation
- Procedure
- Locate the intra-abdominal testis and spermatic cord structures
- Dissect and isolate the testicular vessels
- Ligate the testicular artery
- Second Stage: Orchidopexy
- Timing
- Performed 6 months after the first stage to allow time for revascularization
- Procedure
- Divide the attachments of the testis to abdominal wall
- Mobilise the testicle to check it reseaches to the contra-lateral side so you know you have length
- Groin incision
- Bring testis through the deep ring and down through the inguinal canal into the scrotum
- Orchidopexy
- Postoperative care
- Follow-up to assess testicular function and complications like atrophy or recurrence