Complete epididymal separation presenting as polyorchidism

Sentinel nubbin: A potential pitfall in the management of undescended testis secondary to epididymo-testicular nonunion

INTRODUCTION

Epididymal anomalies are common in boys with undescended testis. Epididymo-testicular non-union with a nubbin in the scrotum is a rare anomaly and may be confusing during management of cryptorchidism. The non-fused epididymis and vas deferens which are descended to the scrotum, may be regarded as nubbin tissue secondary to testicular atrophy and proximal testis may be overlooked.

OBJECTIVE

To evaluate a relatively rare anomaly of epididymo-testicular non-union in which vas deferens and epididymis are descended to the scrotum resembling a nubbin tissue, while a separate testis remains in a proximal peritoneal fold (hernia or processus vaginalis)which could potentially be missed during the management of patients with undescended testis.

STUDY DESIGN

The charts of the fourteen patients with epididymo-testicular non-union and a scrotal nubbin are retrospectively evaluated.

RESULTS

Median age of the patiens was 1.5 years (0.5-12), 11 were left and 3 were right. No connection could be demonstrated between the testis and vaso-epididymal unit in any of the patients. Orchidopexy was performed in 13 patients while orchidectomy in1 patient. The scrotal nubbin tissue is excised in 4 patients and histological examination revealed sections of vas deferens and epididymis. One of the patients underwent inguinal exploration and orchidectomy for assumed testicular atrophy elsewhere but histological examination revealed vas deferens and epididymis without any sign suggesting an atrophic testis. An intrabdominal testis was found incidentally in this patient and he underwent 2 additional procedures for orchidopexy.

DISCUSSION

Although epididymo-testicular anomalies are common in boys with undescended testis, nonunion is the rarest type of this anomaly. Similar cases are reported in the literature as simple fusion anomalies with indefinite clinical significance or even polyorchidism although no accessory testis could be demonstrated. However, the scrotal nubbin tissue which actually contains epididymis and vas is a potential decoy and may result in missing of the proximal testis if regarded as a sign of testicular atrophy and further evaluation is obviated. As this is retrospective study, actual incidence of the condition is yet to be determined.

CONCLUSION

A scrotal nubbin tissue may be secondary to epididymo-testicular nonunion as well as testicular atrophy. As feasibility of radiological imaging studies are limited, a laparoscopic exploration may be considered to confirm or to exclude a separate testis in patients with scrotal nubbin. Prospective studies are needed to evaluate the actual incidence of the condition and gain-loss analysis of laparoscopic exploration.

Polyorchidism in ultrasound examination: A case report

Polyorchidism is usually diagnosed incidentally when the patient undergoes imaging or surgery for some other reason. Although we are facing lack of evidence in different steps of diagnostic and therapeutic workup of these patients, this disorder is usually considered benign, not requiring any intervention. We report the case of a man complaining of a palpable mass in his scrotum. We evaluated the patient using ultrasound, MRI and serum tumour marker level measurement. The patient was finally diagnosed with polyorchidism (three testes). For the management, we recommended annual physical examination, US examination and serum tumour marker level measurement.

High-frequency ultrasound findings in epididymal malformations

PURPOSE

This work aims to investigate high-frequency ultrasound findings in epididymal malformations and their clinical significance.

METHODS

Eighty-five of 9,849 patients who had been examined using high-frequency ultrasound for infertility, varicocele, scrotal swelling, and so on had epididymal malformations. A retrospective analysis was conducted on the ultrasound findings of epididymal malformations in these 85 patients.

RESULTS

There were a total of 117 malformed epididymides in 85 patients with epididymal malformations. The detection rate of epididymal malformations using high-frequency ultrasound was 0.86 % (85/9,849).

CONCLUSIONS

High-frequency ultrasound can be used to diagnose epididymal malformation and seminiferous duct blockage.

Polyorchidism: a meta-analysis

PURPOSE

Polyorchidism is an uncommon congenital anomaly. We systematically analyzed the literature due to the contradictory data regarding this condition.

MATERIALS AND METHODS

We conducted a database search and evaluated relevant articles for the appearance, comorbidities and complications of supernumerary testes. Only cases of polyorchidism confirmed by histological examination were included in the study.

RESULTS

We found 140 cases of polyorchidism. Triorchidism was the most common type, and 6 cases of 4 testes (4.3%) were reported. Most supernumerary testes (64%, chi-square p <0.001) were drained by a vas deferens. Median patient age at detection was 17 years. Left side demonstrated predominance (64.5%, chi-square p <0.001). Most cases were found during surgery for other symptoms including inguinal hernia, undescended testicle, testicular torsion and scrotal pain. Only 16% of patients complained of an accessory mass without any symptoms. Neoplasms were found in 9 cases (6.4%), of which 8 were malignant and 1 was benign. Data available for 7 malignomas (88%) revealed that all were in cryptorchid supernumerary testes.

CONCLUSIONS

Polyorchidism is rare and is generally found during evaluation for other conditions such as inguinal hernia, undescended testis and testicular torsion. Cryptorchidism appears to be the most important risk factor for malignancy in patients with supernumerary testes. Thus, patients with nonscrotal supernumerary testes require appropriate counseling. The supernumerary testis is frequently drained by a vas deferens, implying a probable reproductive function. Decision for surgery, biopsy or orchiectomy should be based on concomitant symptoms, cryptorchidism or suspected malignancy. We provide a guideline for management based on a functional classification of polyorchidism.

Polyorchidism: a case report and classification

Polyorchidism is an uncommon congenital anomaly, defined as the presence of more than 2-histologically proven-testes. Approximately 90 cases are reported in the literature. It is found predominantly on the left side. We report a right-sided polyorchidism found during orchidopexy in a 6-year-old boy. The supernumerary testis had its own tunica vaginalis, epididymis, and deferent duct, but shared the blood supply with the ipsilateral distal testis. The diagnosis was confirmed histologically. Because of the shortness of its vessels, the supernumerary testis could not undergo orchidopexy and was removed. We review the classification systems proposed for polyorchidism. Most are based on embryologic considerations, but none is capable of including all cases described in the literature. Thus, we present an anatomical system for a more comprehensive taxonomy of polyorchidism according to its reproductive function.