✦ Undescended Testis Treatment

Fowler-Stephens Orchidopexy (Two-Stage)

Q: Why does the surgery need two stages?

Clipping the vessels first allows 6 months for alternative vasal blood supply to develop; bringing the testis down immediately on short vessels risks ischaemia.

Q: What is the risk of the testis not surviving?

Testicular atrophy occurs in 15–20% of cases; this is the accepted risk of the most difficult orchidopexy. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Q: Will a Fowler-Stephens testis function normally?

The testis may have reduced spermatogenic function due to prolonged heat exposure, but hormone production is often maintained. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Two-Stage Orchidopexy for High Intra-Abdominal Testis with Short Vessels

45–60 min per stage PROCEDURE

Day Care per stage HOSPITAL STAY

>80% SUCCESS RATE

1 Week per stage RECOVERY

What is Fowler-Stephens Orchidopexy (Two-Stage)?

Fowler-Stephens Orchidopexy is a two-stage procedure for high intra-abdominal testes where spermatic vessel length is insufficient for single-stage orchidopexy. In Stage 1, the spermatic vessels are clipped laparoscopically 2–3 cm above the testis, allowing collateral blood supply via the vasal and cremasteric vessels to develop over 6 months. In Stage 2, the now-vascularised testis is brought down to the scrotum on its vas and collateral vessels. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care per stage.

Boys with high intra-abdominal undescended testis where vessel length is insufficient for single-stage orchidopexy, confirmed at laparoscopic assessment. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Stage 1 — Laparoscopic Assessment

Laparoscopy confirms high intra-abdominal testis with short vessels insufficient for single-stage descent.

Vessel Clipping

Spermatic vessels clipped 2–3 cm above the testis allowing collateral vasal and cremasteric vessels to develop.

6-Month Interval

Patient observed for 6 months while vasal and cremasteric collaterals develop sufficient blood supply.

Stage 2 — Testicular Mobilisation

Laparoscopy or open: testis now has adequate collateral blood supply for safe descent.

Scrotal Placement

Testis mobilised on vasal vessels; brought through neo-hiatus into scrotal dartos pouch.

Outcomes

45–60 min per stageDURATION

Day Care per stageHOSPITAL STAY

>80%SUCCESS RATE

1 Week per stageFULL RECOVERY

Who Needs This Treatment?

→Provides the only safe route to the scrotum for high intra-abdominal testes with short vessels.
→Two-stage approach establishes alternative blood supply preventing ischaemia.
→80% testicular viability rate in experienced centres.
→Avoids orchidectomy — preserves gonadal tissue and hormone production.
→Laparoscopic stages provide minimal incision and rapid recovery.
→Provides best chance of a viable scrotal testis in the most challenging cases.

"Fowler-Stephens orchidopexy is our solution for the most challenging undescended testis cases. Two stages and six months of patience give us the best chance of a viable, functioning testis in the scrotum."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Why does the surgery need two stages?+

What is the risk of the testis not surviving?+

Will a Fowler-Stephens testis function normally?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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