SynthesisPediatric surgery international2026
Testicular atrophy rate in single-stage versus two-stage fowler-stephens orchidopexy: a systematic review and meta-analysis.
Synthesis in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundManaging intra-abdominal testes is particularly challenging, especially when short testicular vessels require division. Fowler–Stephens orchiopexy remains the standard approach in such cases, but whether it is more effective when performed in a single or two stages remains uncertain. This review aims to provide a clear, updated comparison of testicular atrophy rates following single-stage (SS) versus two-stage (TS) FSO.
methodsA systematic search of PubMed/MEDLINE and Google Scholar was conducted until May 2025 in accordance with PRISMA 2020 guidelines. Studies comparing SS-FSO and TS-FSO in boys with intra-abdominal testes were included. The primary outcome was postoperative testicular atrophy. Risk of bias was assessed using the RoB-2 and ROBINS-I tools. Meta-analysis was performed in JASP using log risk ratios under random- and fixed-effect models, with heterogeneity, prediction intervals, and publication bias evaluated using established statistical methods.
resultsTwenty-two studies involving 743 testes met the inclusion criteria. Atrophy rates were consistently higher after SS-FSO (3–20%) than after TS-FSO (0–12%). The combined analysis indicated that TS-FSO significantly reduced the risk of atrophy (log RR 0.50; 95% CI 0.15–0.84; p = 0.005), corresponding to approximately a 40–50% relative risk reduction. All studies showed a similar trend, with no heterogeneity (I²=0%). The prediction interval also supported TS-FSO, and funnel plot assessments revealed no evidence of publication bias. Overall, the certainty of evidence was rated as low due to confounding in observational studies and the limited number of high-quality trials.
conclusionThis review demonstrated that TS-FSO provides a more reliable reduction in testicular atrophy than SS-FSO for intra-abdominal testes requiring vessel division. Although much of the evidence is observational, the consistency and robustness of the findings support TS-FSO as the preferred method. Carefully planned prospective studies are crucial for refining patient selection criteria and facilitating personalised surgical decision-making.
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