Triorchidism: a case report and review of similar conditions

Inguinal Polyorchidism Found Incidentally During Orchiopexy in 9-Year-Old Male: A Case Report and Review of Orchiopexy of Nonscrotal Supernumerary Testes

Polyorchidism, the presence of more than two testes, usually presents as a painless scrotal mass or is diagnosed incidentally during the management of another condition.1 It is a rare congenital abnormality with approximately 200 reported cases in the literature. Most cases are found on the left side within the scrotum. We report a case of right-sided polyorchidism in a 9-year-old patient found incidentally during inguinal orchiopexy. As there is debate on the management of polyorchidism, a careful approach is required as the surgeon must decide between either scrotal fixation or the removal of the supernumerary testis. This case report will discuss the anatomical and clinical considerations when making this decision.

Polyorchidism: An Up-to-Date Systematic Review

Polyorchidism is a rare male urogenital tract anomaly characterized by at least one supernumerary testis in the scrotum or ectopically. According to data based on our systematic review, 76% of the supernumerary testes (SNTs) were located in the scrotum, and 24% were extra-scrotal (p < 0.001). Among testes located outside the scrotum, 87% were found in the inguinal canal and 13% in the abdominal cavity. In 80% of cases, the diagnosis of SNT was made based on imaging tests, and the remaining 20% of cases were detected incidentally during surgery. The imaging tests performed (US or MRI) resulted in a significantly higher rate of patients who qualified for observation vs. surgical treatment (45% vs. 35%, p < 0.001). The most common conditions associated with SNT were ipsilateral inguinal hernia (15% of cases) and cryptorchidism (15% of cases). Surgery (orchidopexy/orchidectomy) was performed on 54% of patients with SNT, and the decision to observe the SNT was made in a total of 46% of patients (p = 0.001). The therapeutic approach depends on the location of the SNT and the presence of factors that raise suspicion of neoplastic proliferation.

Triorchidism, a Rare Genitourinary Anomaly: A Case Series

Triorchidism is the most common type of polyorchidism. In general, polyorchidism is a rare congenital anomaly that has been reported in around two hundred cases to date. We report a case series on 5- and 12-year-old boys that visited our hospital for undescended testis, and during intervention, triorchidism was found incidentally. This case series offers brief discussion on polyorchidism and its management principles ascribed in different literatures.

Polyorchidism during orchidopexy; A case report with review of literature

Polyorchidism is a rare congenital urologic abnormality. It is usually diagnosed incidentally by imaging or during surgery. We report a case of triorchidism, in a 2 years old boy which was discovered during elective orchidopexy. The testes was localized in the inguinal region and was of normal size. We opted for orchidopexy of this supernumeray testis due to its size and its ability to reach the scrotum. The preservation of the supernumerary testis has been a controversial issue. This case report offers brief discussion of polyorchidism with review of similar literature.

Management of Incidental Finding of Triorchidism Diagnosed During Routine Hernia Repair

Polyorchidism is a rare congenital anomaly which refers to the presence of more than two intra- or extrascrotal testicles. Triorchidism, the presence of one extra testicle is the most common type. This report describes the case of a 29-year-old male who was found to have a right supernumerary undescended testis encountered incidentally during hernia repair. With this in mind, the current knowledge of management of supernumerary testis was analysed, including potential scenarios, to delineate what a urologist should do when a supernumerary testis is found during routine surgical procedures such as orchidopexy or hernia repair.

Doppler ultrasound findings in a patient with primary infertility and triorchidism

Polyorchidism, presence of more than two testes in a scrotum, is a rare clinical entity. To date, about 200 cases have been reported in the literature. We report a case of triorchidism in a patient presenting with a 7-year history of primary infertility. Clinical examination revealed two completely separate testes with two separate epididymides and single vas suggesting a complete division of the genital ridge and partial duplication of the vas deferens. In our patient, the clinical picture together with ultrasound findings were characteristic enough to exclude other diagnoses, allowing conservative management. We also present the Doppler ultrasound findings of this rare condition, which may be helpful for comparison in patients with triorchidism who present with testicular torsion.

Report of a boy with polyorchidism and a review of current knowledge regarding this unusual anomaly

Polyorchidism is an extremely rare testicular malformation in children, and its etiology is unknown. There is an increased risk for testicular malignancy in these patients and a common association with other abnormalities, such as cryptorchidism, inguinal hernia, testicular torsion, hydrocele, and varicocele. There are insufficient data in the literature on the ideal management of polyorchidism. We report a 14-year-old boy with polyorchidism and review the current literature regarding this anomaly. Physical examination revealed a discrete, painless, left intrascrotal lump. αFP, β-hCG and LDH were normal. Scrotal ultrasound showed a well-circumscribed tissue in the left hemiscrotum measuring 2.5×2.0×1.3 cm and having the same echo-genicity as the normal testes. Color Doppler study and magnetic resonance imaging also confirmed the tissue as a third testis with its own epididymis draining to a common vas. The testis was left in situ, and the patient was managed conservatively. Polyorchidism should be considered in the differential diagnosis of all scrotal masses. The etiology of polyorchidism is thought to be accidental division of the genital ridge before 8 weeks of gestation. The cases are divided into two categories according to anatomical properties, such as having drainage to an epididymis and vas deferens. The majority of cases are mainly encountered during evaluation for the other symptoms associated. Recent evidence supports that these cases may be followed conservatively when clinical findings and imaging techniques detect no complications or suspicion for malignancy, torsion, hernia, or cryptorchidism.

Triorchidism: two case reports

In this study, two cases of triorchidism are reported. The first case (29 years) had two right discrete ovoid nontender, firm, mobile lumps with testicular sensation. The second case (32 years) had two left discrete ovoid nontender, firm, mobile lumps with normal testicular sensation. They were subjected to the estimation of serum follicle-stimulating hormone, luteinising hormone, free and total testosterone, alpha-fetoprotein, prostate-specific antigen, karyotyping and semen analysis. Imaging included ultrasonography, transrectal ultrasound, magnetic resonance imaging and intravenous pyelography. The first case had two testes in the right side. Each one had an epididymis where one vas deferens was palpated. The second case had two left testes with normal testicular sensation. The lower left lump represented normal-sized testis attached to its epididymis and a single palpated vas deferens. Diagnosis of the first case was triorchidism associated with left varicocele (grade I) with oligoasthenoteratozoospermic semen profile. Intracytoplasmic sperm injection was carried out resulting in a twin. Diagnosis of the second case was triorchidism with accessory testis on the left side associated with left varicocele (grade I) and asthenozoospermic semen profile that was submitted to medical treatment. It is concluded that triorchidism is an uncommon congenital anomaly that should be not overlooked in diagnosing scrotal masses.

Unusual scrotal pathology: an overview

The diverse embryological origins of the contents of the scrotum create an environment that fosters a wide variety of unusual pathologies. Most scrotal pathologies are discovered by the patient and are initially evaluated by a thorough physical examination and scrotal ultrasonography. Scrotal lesions can be broadly grouped by the anatomical location in which they develop; the clinician must consider a wide differential diagnosis based on this location. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist, including ectopic tissue, metastasis, and other neoplastic growths. Rete testis lesions are classified as developmental, benign or malignant. Cystic lesions of the epididymis are most commonly benign, but malignant neoplasms can also be present. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and is a common location for ectopic tissue and metastatic disease; a narrower range of lesions develop in the scrotal wall because of its simpler anatomy. Treatment options range from conservative observation to wide surgical excision and should be considered carefully; the aim of therapy is to remove malignant or potentially malignant tissue while minimizing effects on fertility and function.