Occurrence of polyorchidism in a young man

Sonographically diagnosed and conservatively managed case of polyorchidism: A case report

Polyorchidism is a congenital abnormality with distinct sonographic characteristics. In most cases, sonography is sufficient for diagnosis. In instances of complicated polyorchidism, an MRI may provide further information. Conservative treatment with sonographic follow-up is the best management option in uncomplicated cases. We present a rare case of polyorchidism with no associated complications that were managed conservatively with periodic follow-up imaging.

Three testicles in one hemiscrotum: an unusual presentation of polyorchidism

Polyorchidism, or more than one testicle in a hemiscrotum, is a relatively rare phenomenon. It is often associated with several other conditions, including inguinal hernia, testicular maldescent, testicular torsion, hydrocele or hypospadias. In this report, we describe a patient who presented with three testicles in one hemiscrotum, which is a highly unusual presentation for an already uncommon condition. We also review the relevant literature as it relates to the need for surveillance due to the increased risk for malignancy.

Functional supernumerary testis in a child with testicular torsion and review of polyorchidism

Histologically confirmed polyorchidism is an uncommon condition. The majority of cases are asymptomatic and associated with inguinal hernia or cryptorchidism. There are few reported cases of pediatric supernumerary testis presenting with testicular torsion. We present a case of missed torsion with incidentally detected triorchidism as well as an overview of pediatric polyorchidism.

Torsion of bilobed testis and biopsy-proven ipsilateral supernumerary testis in an adolescent

Testicular torsion in patients with polyorchidism is rare, with less than 20 cases being reported. Bilobed testis has only been reported once in the literature to date. We report an interesting case of polyorchidism with torsion of an ipsilateral bilobed testis. The abnormal looking bilobed infarcted testis was removed, but the smaller viable supernumerary testis was biopsied and preserved.

Polyorchidism: sonographic and magnetic resonance imaging findings

Polyorchidism is a rare anomaly and frequently associated with criptorchidism, inguinal hernia and testicular torsion. It is also reported as increased risk of testicular malignancy. We report a case of 23 year old man with left supernumerary testis in the left hemiscrotum. He presented with painless mass in his left hemiscrotum. Normal physical examination and laboratory tests including spermiogram were examined. Both ultrasound and MRI examinations revealed polyorchidism without malignancy or any other concomitant features. In most cases sonography alone is diagnostic. MRI may provide additional information in complicated cases of polyorchidism. Conservative treatment with sonographic follow-up is the choice of treatment in uncomplicated cases.

Bilobed testicle in children: diagnosis and management

Bilobed testicle is an extremely rare testicular malformation in children. It may be presumed that this condition could be an incomplete expression of polyorchidism; however, the etiology of both entities remains unknown. In this report, a 3-year-old boy presented with a right bilobed testicle mimicking a testicular tumour. Since there are insufficient data in the pediatric literature presenting the ideal management of bilobed testicles, we believe it is important to report this case to provide more information about this condition. Although rare, bilobed testis should be considered in the differential diagnosis of a testicular mass. Surgical treatment is not mandatory, and conservative follow-up may play a role.

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 review of the literature]

Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.

Sonography of Benign Intrascrotal Lesions

Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.

Polyorchidism: sonographic and magnetic resonance image findings

Polyorchidism is a rare congenital anomaly frequently associated with maldescent testis, hernia, and torsion. Reports in the literature show an increased risk of testicular malignancy in the presence of polyorchidism. This entity has characteristic sonographic features and the diagnosis is often made on the basis of sonography. Magnetic resonance imaging might also be used for the diagnosis, but is more helpful in cases associated with cryptorchism or neoplasia. A conservative approach is the treatment of choice in uncomplicated cases.

Polyorchidism and torsion. A lesson from 2 cases

Two cases of polyorchidism with 2 left scrotal testes are referred. In both patients, the segmented gonads showed a "bell clapper" deformity. In the first patient, the contralateral gonad also presented a large mesorchium and absence of scrotal ligament, whereas in the second case, the right gonad was firmly adhered to the tunica vaginalis because of a previous appendix testis torsion. Orchidopexy of all testes, judged at risk for torsion, was performed. Contrary to what is recommended by recent literature, we consider scrotal exploration and testis fixation mandatory of the contralateral, apparently normal gonad as well, even in the absence of clinical and ultrasound signs of associated abnormalities or complications.

Hodentorsion bei Doppelhoden

We describe a case of testicular duplication presenting as torsion of the supernumerary distal testis in a 14-year-old boy. Clinical examination showed an unclear mass above the left testis; intraoperatively, the supernumerary testis was linked to the regular testis by a common epididymis and shared a common vas with it. The distal testis was resected due to severe hemorrhagic damage. This condition represents the result of transversal division of the wolffian duct during organogenesis. Review of the literature revealed that testicular torsion, testicular tumor, unclear scrotal masses, or continuing potentia generandi after bilateral vasectomy were the reasons that polyorchidism was detected.