Laparoscopic Fowler–Stephens Orchidopexy for Non-Palpable Testes in Children: Outcomes and Risk Factors for Postoperative Testicular Atrophy in a 72-Patient Cohort

Background Non-palpable testes (NPT) represent a challenging form of cryptorchidism that often requires advanced surgical management. Two-stage laparoscopic Fowler–Stephens (FS) orchidopexy is widely used for high intra-abdominal testes to achieve scrotal placement while preserving testicular viability. This study aimed to evaluate the outcomes of this technique and identify risk factors associated with postoperative testicular atrophy. Methods We retrospectively analyzed 72 children with 83 NPT who underwent two-stage laparoscopic FS orchidopexy at Habib Thameur Hospital between 2013 and 2022. Demographic characteristics, intraoperative findings, testicular position and volume, presence of epididymo-testicular dissociation (DET), surgical details, and postoperative outcomes were reviewed. Testicular atrophy was defined as a reduction in testicular volume greater than 50% or absence of vascular flow on Doppler ultrasound. Univariate and multivariate logistic regression analyses were performed to determine predictors of surgical failure. Results The mean age at surgery was 3.5 years, and DET was identified in 26.5% of cases. The mean interval between the two stages was 11 months. After a mean follow-up of 17 months, successful scrotal positioning was achieved in 86% of testes. Testicular atrophy occurred in 4.7% of cases, and one patient required reoperation due to retraction. Multivariate analysis revealed that DET and an interval of at least one year between surgical stages were independent predictors of failure. Conclusion These findings support the effectiveness of two-stage FS orchidopexy for NPT, with low rates of complications. Careful surgical planning, appropriate staging intervals, and close monitoring of DET cases are essential to optimize outcomes.