Clinical Effect Of Single-stage Fowler-Stephens Laparoscopic Orchidopexy For High Cryptorchidism

Objective:To evaluate the clinical effect of single-stage Fowler-Stephens laparoscopic orchidopexy in the treatment of high cryptorchidism.Methods:Retrospective analysis was performed on 20 patients with high undescended torchidism who received laparoscopic Fowler-Stephens one-stage orchiopexy in the Department of Urology,Children’s Hospital Affiliated to the Capital Pediatric Research Institute from January 2015 to April 2019 as the observation group,and 37 patients with middle and high undescended torchidism who received laparoscopic orchiopexy in the same age group as the control group during the same period.Two groups of patients were compared in clinical treatment effect(operative time,postoperative complications and overall satisfaction).The testicular position,testicular volume and sex hormone test of each case were reexamined 6 months after surgery.All the results were compared with each other,and a comparative study was conducted between the groups.Results:All patients in the observation group and the control group were fixed in the scrotum under laparoscopy,and no transfer was made to open surgery.The average operation time of the observation group was 43.25±8.14min,while the average operation time of the control group was 45.76±5.39min.There was no statistical significance between the two groups(r=1.3948,P=0.1687>0.05).Postoperative complications:(1)Scrotal hematoma:No postoperative complications occurred in 19 patients in the observation group,while 3 patients in the control group(X2=0.3092,P=0.545>0.05).(2)Position of testicles:the testicles of all cases in the observation group were located in the middle of the scrotum and fixed well after reexamination 6 months after surgery.In the control group,6 months after surgery,36 patients had testicles located in the middle of the scrotum,and 1 patient had testicles retraction,located at the entrance of the scrotum.(3)Testicular atrophy:Doppler ultrasonography in both the observation group and the control group showed good testicular blood supply and no testicular atrophy 6 months after surgery.(4)Comprehensive satisfaction:in the observation group,1 case was dissatisfied and 19 cases were satisfied after a follow-up visit 6 months after surgery;In the control group,3 cases were dissatisfied and 34 cases were satisfied(χ2=0.0623,P=0.802>0.05).There was no significant difference in clinical treatment effect between the two groups.The preoperative average testicular volume of the observation group was 0.7632±0.0458cm3,and that of the reexamination 6 months after surgery was 0.7865±0.0726cm3.The preoperative average testicular volume of the control group was 0.7703±0.0507cm3,and that of the reexamination 6 months after surgery was 0.7914±0.0697cm3.There was no statistically significant difference in the preoperative and postoperative testicular volume between the two groups(t=0.5121,0.6174,P=0.611,0.429).The observation group and the control group were examined for sex hormones,including testosterone(T),Estradiol(E2),follicle stimulating hormone(FSH)and luteinizing hormone(LH)before and 6 months after surgery.There was no statistically significant difference in FSH between the two groups before surgery(t=0.276,P=0.784),and there was statistically significant difference in FSH between the two groups after surgery(t=0.392,P=0.021).There were no significant changes in T,E2 and LH before and after operation.Conclusion:1.Laparoscopic F-S one-stage testicular fixation can reduce hospitalization,anesthesia and operation times,relieve pain of children and reduce treatment costs.Laparoscopic surgery has better operating field and larger operating space,can quickly find the testis in the abdominal cavity,reduce the time of surgical exploration and damage.2.Laparoscopic F-S one-stage testicular fixation has a satisfactory clinical effect and is an effective surgical method for the treatment of high cryptorchidism,which is worthy of further promotion.3.Spermatic vasculotomy has an effect on the changes of FSH in the short term,suggesting the risk of short-term testicular injury.Therefore,clinical selection of this operation method should be cautious and fully evaluated.