Polyorchidism presenting as retractile testes

The testis: the unusual, the rare and the bizarre

Ultrasound is the preferred technique when imaging the scrotal contents. Although appearances of many of the more common abnormalities present the examiner with no diagnostic difficulty, the more unusual conditions may present a considerable challenge. Many normal variants, unusual and rare abnormalities may be instantly recognized once seen. The current review highlights the more unusual and rare conditions affecting the scrotal contents in order to allow the reader the opportunity to gain knowledge of their existence and to aid future interpretation of the difficult examination.

[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.

Complete epididymal separation presenting as polyorchidism

We describe an unusual case of a 21-month-old boy with complete separation of the testis and epididymis. Two homogeneous structures were observed in the scrotum of a newborn boy in addition to a third structure. Polyorchidism was suspected, but follow-up sonographic studies showed a decrease in the echogenicity of the left scrotal structure. Surgical exploration revealed the testis and epididymis to be completely separated, with no duplicated testis. Orchidopexy was then performed.

Abdominal polyorchidism: A case report and review of the literature

Abdominal polyorchidism is rare. We report a case and review the literature. We suggest a very watchful abdominal evaluation of patients for a second ipsilateral testis who are operated for undescent testis. Polyorchidism is a very rare anomaly which requires definitive histological diagnosis. Although imaging techniques may be helpful in the diagnosis, it's mostly incidentally found in surgical exploration. Patients may present with pain or scrotal swelling. Most commonly abnormalities are maldescent (40%), hernia (30%), torsion (15%), hydrocele (9%) and malignancy (6%).

Bilateral double testis: Evaluation by magnetic resonance imaging

Bilateral double testis, a varient of polyorchidism, is a rare malformation of which six cases have been reported in the published literature. Magnetic resonance imaging was used in the presented case to confirm the diagnosis without surgical exploration.