DOI: 10.69601/meandrosmdj.1957297 ISSN: 2149-9063

Impact of Gubernaculum Preservation on Testicular Outcomes in Two-Stage Fowler–Stephens Orchiopexy

Bilge Türedi Sezer, Ali Sezer
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Objective: To evaluate the impact of gubernaculum preservation on surgical outcomes and testicular viability in patients undergoing Fowler–Stephens orchiopexy (FSO) for intra-abdominal testes.Materials and Methods: Medical records of patients with non-palpable intra-abdominal testes managed between March 2021 and March 2025 were retrospectively reviewed. Patients undergoing gubernaculum-sparing orchiopexy for testes located ≥2 cm proximal to the internal inguinal ring were included. All patients underwent laparoscopic staged Fowler–Stephens orchiopexy with preservation of gubernacular and collateral vascular structures. Demographic characteristics, operative findings, postoperative complications, and follow-up outcomes were analyzed retrospectively. Surgical success was defined as maintenance of the testis in a stable scrotal position without evidence of atrophy.Results: A total of 20 patients underwent staged surgical management for intra-abdominal testes during the study period. Among these, 13 patients with 15 testes underwent gubernaculum-sparing Fowler–Stephens orchiopexy and constituted the study cohort. Mean age at surgery was 4.0 ± 2.8 years, and mean follow-up duration was 1.5 ± 0.9 years. Testicular atrophy developed in one testis, while one additional testis demonstrated postoperative hypotrophy on ultrasonographic evaluation. Overall anatomical success was achieved in all cases, whereas testicular survival without atrophy was observed in 13 of 15 testes (86.6%). Postoperative complications were minimal, and no patient required redo surgery.Conclusion: Gubernaculum-preserving staged Fowler–Stephens orchiopexy appears to be a safe and effective technique with favorable anatomical and functional outcomes in selected patients with high intra-abdominal testes. Preservation of gubernacular collateral circulation may contribute to improved postoperative testicular viability. Further prospective studies with longer follow-up are needed to clarify the long-term benefits of this approach.

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