Chengjun Yu1, Chunlan Long2, Yi Wei3, Xiangliang Tang4, Bin Liu5, Lianju Shen6, Xueyi Dong7, Tao Lin8, Dawei He9, Shengde Wu10, Guanghui Wei11. 1. Department of Urology, Children's Hospital of Chongqing Medical University, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China. Electronic address: 398429065@qq.com. 2. Ministry of Education Key Laboratory of Child Development and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics Chongqing, China. Electronic address: 332005363@qq.com. 3. Department of Urology, Children's Hospital of Chongqing Medical University, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China. Electronic address: 351187861@qq.com. 4. Department of Urology, Children's Hospital of Chongqing Medical University, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China. Electronic address: 313830881@qq.com. 5. Department of Urology, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China. Electronic address: 458018708@qq.com. 6. Department of Urology, Children's Hospital of Chongqing Medical University, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China. Electronic address: 384851872@qq.com. 7. College of Life Science, Zhejiang University, China. Electronic address: dong.x@wehi.edu.au. 8. Department of Urology, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China. Electronic address: 2169575045@qq.com. 9. Department of Urology, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China. Electronic address: 3192482030@qq.com. 10. Department of Urology, Children's Hospital of Chongqing Medical University, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; Chongqing Key Laboratory of Pediatrics Chongqing, China. Electronic address: shengdewu@yeah.net. 11. Department of Urology, Children's Hospital of Chongqing Medical University, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; Chongqing Key Laboratory of Pediatrics Chongqing, China. Electronic address: u806806@cqmu.com.
Abstract
BACKGROUND AND OBJECTIVE: 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 or 2-stage, open or laparoscopic. METHODS: The databases PubMed, Cochrane Library, Web of Science Database, Russian Science Citation Index, SciELO Citation Index, China National Knowledge Infrastructure, WanFang Data, and China Biology Medical disc were systematically searched for relevant articles. RESULTS: Sixty studies involving 1991 operated testes were included in the final analysis. The overall success rates for 1- and 2-stage FSOs were 85% 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 of 2-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, and laparoscopic superior to open. 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% to 89%. 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.
BACKGROUND AND OBJECTIVE: 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 or 2-stage, open or laparoscopic. METHODS: The databases PubMed, Cochrane Library, Web of Science Database, Russian Science Citation Index, SciELO Citation Index, China National Knowledge Infrastructure, WanFang Data, and China Biology Medical disc were systematically searched for relevant articles. RESULTS: Sixty studies involving 1991 operated testes were included in the final analysis. The overall success rates for 1- and 2-stage FSOs were 85% 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 of 2-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, and laparoscopic superior to open. 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% to 89%. 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.