Evaluation Of Fowler–Stephens Orchiopexy For High-Level Intra-Abdominal Cryptorchidism:A Systematic Review And Meta-Analysis

Background: There has been no consensus regarding the best surgical strategy for patients with cryptorchidism involving high-level intra-abdominal testes.This systematic review and meta-analysis compared the outcomes of Fowler–Stephens orchiopexy(FSO)conducted as 1-stage or2-stage,open or laparoscopic.Methods: The databases PubMed,Cochrane Library,Web of Science Database,Russian Science Citation Index,Sci ELO Citation Index,China National Knowledge Infrastructure,Wan Fang Data,and China Biology Medical disc were systematically searched for relevant articles.Results: A Sixty studies involving 1991 operated testes were included in the final analysis.The overall success rates for 1-and 2-stage FSOs were85% and 87%,respectively;overall atrophy rates for both were 10%.The success rates of 1-stage FSOs,open and laparoscopic,were 83% and 87%;with atrophy rates of 12% and 8%.The corresponding success rates of2-stage FSOs were 81% and 89%;with atrophy rates of 17% and 8%.The odds ratios indicated that 2-stage FSO was significantly superior to 1-stage(OR: 1.71,95% CI: 1.08-2.73;P = 0.02;I2 = 17%),and laparoscopic superior to open(OR: 1.72,95% CI: 1.05-2.81;P= 0.03;I2= 11%).Evaluating laparoscopic FSO over time,the success rates prior to year 2000,2000 through 2010,and after 2010 were 85%,89%,and 88%,and atrophy rates were 15%,9%,and 6%,with no heterogeneity in the reports,and the funnel plot showed no publication bias.Conclusion: Each surgical technique for correcting high-level intra-abdominal testes(IATs)had an acceptable success rate,from 81% to89%.However,in terms of highest success rate and lowest atrophy rate,2-stage laparoscopic FSO is the first choice for treating high intra-abdominal cryptorchidism.