Laparoscopy and Fowler-Stephens orchiopexy in the management of the impalpable testis.

In children with an impalpable testis, laparoscopy is a valuable procedure that can be used in conjunction with inguinal and abdominal exploration to localize the testis. The instrumentation and technique of laparoscopy are described. If the testis is intra-abdominal, a Fowler-Stephens orchiopexy often is successful. Staging the Fowler-Stephens orchiopexy, with preliminary ligation of the testicular vessels in situ, followed 6 months later with transection of the vessels and orchiopexy, may improve the success of this technique by allowing collateral arterial flow to develop with minimal risk of arterial spasm.