Vital dye lymphoscintigraphy: An answer to decision making between single or two-stage laparoscopic Fowler-Stephens orchidopexy intraoperatively

Abstract

Abstract Introduction We hypothesized that vital dye lymphoscintigraphy (VDL) can be used to assess the testicular supply via vessel to vas and can be used to decide whether to go for single-stage Fowler-Stephens (FS1) or two-staged Fowler-Stephens (FS2) orchidopexy. We aimed to compare the clinical outcomes of FS1 and FS2 orchidopexy and to assess the role of the VDL technique. Methods A prospective study was done to include patients with high intraabdominal testis. They were subjected to the study protocol. During laparoscopic FS orchidopexy, VDL was performed. Around 0.5ml subcapsular injection of methylene blue was administered in the testis. The flow of methylene blue was observed and categorized as definitive, intermediate, or no flow along the vas for 10 mins. Testicular volume, testicular atrophy index, and hormonal response were studied and compared between the two groups. The post-operative relative testis atrophy percentage was calculated. Result The outcome of FS1 and FS2 orchidopexy was similar in terms of testicular volume, testicular atrophy index, and hormonal response. On VDL, 6 patients had no flow, of which 2 had FS1 and 4 FS2. The two patients who had no flow on VDL and had FS1, both developed testicular atrophy post-operatively. The four patients who had no flow on VDL and had FS2, none had testicular atrophy. Conclusion The outcome of FS1 and FS2 orchidopexy was similar. VDL can be used intraoperatively for deciding between the FS1 and FS2 orchidopexy. If VDL is added for intraoperative vascularity assessment, FS1 can be used as standard treatment for high intraabdominal testis.