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11–14 APRIL, 2018, HELSINKI, FINLAND
18:28–18:43
HS-6 (LO)
THE DEVELOPMENT OF THE FOWLER-STEPHENS
ORCHIOPEXY
Alexandra REHFUSS and Barry A. KOGAN
Albany Medical Center, Albany, New York, USA
ABSTRACT
Anatomical descriptions of the undescended testicle date back to the eighteenth century. In 1762,
John Hunter was the first to describe the abdominal position of the fetal testis, the gubernaculum,
and the descent of the fetal testis into the scrotum. These findings paved the way to understanding
the etiology of the undescended testicle. It was not until 1871 that the first attempt at correcting
cryptorchidism was recorded. However, early attempts were complicated by morbidity secondary
to the high risk of infection at that time. As surgeons continued to work on modifying the orchiopexy
procedure, it was recognized that the high intra-abdominal testis posed a unique challenge. In
1959, Robert Fowler joined Douglas Stephens’ research unit at the Royal Children’s Hospital in
Melbourne, and together they made groundbreaking discoveries of testicular vascular anatomy.
They found that the testicular artery has collateral communications with the vasal and cremasteric
arteries, and therefore high ligation of the testicular artery allows for collateral blood flow to the
testicle while affording more length to the spermatic cord and therefore a successful orchiopexy.
Since its’ inception, the Fowler-Stephens orchiopexy has evolved with technological advances.
The implications of Fowler and Stephens’ discovery have been long lasting and have resulted in
improved salvage rates of intra-abdominal testes.