Introduction & Objective : Patients undergoing a two-stage Fowler-Stephens laparoscopic orchidopexy for intra-abdominal testes are typically recommended to undergo the second stage 4-6 months after the first stage. As part of a quality care initiative, our studied examined if patients were following up within this window and, if not, why patients were lost to follow up.
Methods : We retrospectively reviewed a cohort of 105 patients who underwent the first stage of a 2-stage Fowler-Stephens orchidopexy at our institution between 1/2005 and 1/2015. Bivariate and multivariate analyses were performed to compare clinical, surgical, and socioeconomic factors. Patients identified as having undergone the first but not second stage procedure were contacted in an attempt to schedule the second stage procedure.
Results : Of the 105 patients, the mean and median interval between the 1st and 2nd stage procedure was 7.2 months and 5 months (2-65 months) . Twenty-seven of the 105 patients (25.7%) followed up >6 months after their first stage procedure. Four (3.8%) did not ever undergo a second stage procedure at our institution. Three patients were not able to be contacted. Contact was re-established with one patient who subsequently underwent the second stage of the procedure at 8 years of age, 45 months after the first stage procedure. The parents chose to not follow up for the second stage due to fear of another procedure under general anesthesia, despite knowledge that a second procedure would be required.Of patients who completed the second stage of their Fowler-Stephens, those that were older were less likely to have followed up within 4-6 months. (OR 0.78 p=0.02.)
Conclusions : Although uncommon,some patients offered a two-staged operation will not follow up for the second stage, highlighting the importance of thorough counseling. As patients with undescended testicles get older, they are less likely to follow up within the recommended time frame. Protocols for routinely contacting patients 3 months after a first stage Fowler-Stephens orchidopexy could potentially improve parental compliance with standard recommendations for timing of the 2nd stage.