Laparoscopy for non-palpable undescended testis: comparing outcomes in syndromic and non-syndromic children.

PURPOSE: Boys with genetic syndromes have an increased risk of undescended testes (UDT), but laparoscopic findings and outcomes after two-stage Fowler-Stephens orchiopexy (FS2) are rarely reported. This study aims to compare laparoscopic findings and results after FS2 between syndromic and non-syndromic boys. METHODS: A retrospective cohort study on boys with UDT who underwent laparoscopy between 2014 and 2024. Syndromic and non-syndromic patients were compared regarding age at surgery, bilaterality, type of UDT, and atrophy rate after FS2. RESULTS: In total, 190 boys with 298 testicles underwent laparoscopy. Of these, 42% were found to be intra-abdominal, 23% were vanishing testes and in 22% of cases, a testicular nubbin was found. Bilateral (p < 0.001) and intra-abdominal UDT (p < 0.01) were significantly more common in children with syndromes, whereas testicular nubbin was less common (p < 0.01). The median age at laparoscopy was higher in the group with syndromes. Atrophy occurred in 20% of all testicles undergoing FS2, with no significant difference in outcome between groups (p > 0,05). CONCLUSION: Syndromic boys present with more severe UDT but achieve comparable outcomes after FS2. Early diagnosis and individualized management are essential to preserve testicular viability in this high-risk group.