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Pliszka A, Wawrzyniak A, Walocha J, Musiał A, Bonczar M, Ostrowski T, Polguj M, Wysiadecki G, Clarke E, Tubbs RS, Balawender K. Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review. Clin Anat 2024; 37:405-412. [PMID: 37493239 DOI: 10.1002/ca.24093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.
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Affiliation(s)
- Anna Pliszka
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Rzeszow University Medical College, Rzeszow, Poland
| | - Agata Wawrzyniak
- Department of Histology and Embryology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Agata Musiał
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Tomasz Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Edward Clarke
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Structural and Cellular Biology, Tulane University School of Medicine, Louisiana, USA
| | - Krzysztof Balawender
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Rzeszow University Medical College, Rzeszow, Poland
- Department of Clinical Urology and Urological Oncology, Municipal Hospital of Rzeszow, Rzeszow, Poland
- Faculty of Medicine, University Sulkhan-Saba Orbeliani University LLC, Tbilisi, Georgia
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Sarmiento B, Ellsworth P, Seth A. Inguinal Polyorchidism Found Incidentally During Orchiopexy in 9-Year-Old Male: A Case Report and Review of Orchiopexy of Nonscrotal Supernumerary Testes. Urology 2024; 184:e235-e238. [PMID: 37951364 DOI: 10.1016/j.urology.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
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.
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Bayissa BB, Tesfaye D. Triorchidism; an incidental finding at inguinal hernia repair: A case report. Int J Surg Case Rep 2020; 77:813-815. [PMID: 33395902 PMCID: PMC7724094 DOI: 10.1016/j.ijscr.2020.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Polyorchidism is a rare congenital malformation with about 200 cases reported in literatures. Triorchidism and left side occurrence are the most common presentation. This case report was aimed to report the rare presentation of polyorchidism which was on the right side and along with incarcerated inguinal that make it by far the least encountered presentation. The intraoperative management for the polyorchidism was an issue of dilemma but adult type can be excised safely. PRESENTATION OF THE CASE A 43 year old farmer presented with right side inguino-scrotal mass and recent failure to reduce to abdomen. He used to have pain lower abdominal pain with slight pressure since childhood but didn't get any medical evaluation. He has completed his family number and didn't complain any sexual problem. Physical examination showed that there was non-tender irreducible soft right side inguino-scrotal mass. The right side testis was not appreciated. DISCUSSION Triorchidism is one of the commonly occurring variant of supernumerary testes that diagnosed incidentally during investigations or interventions for other pathologies. Incarcerated inguinal hernia masks its detection on physical examinations, so its diagnosis is more of intraoperative making a one time management for both pathologies at single operation especially if the operation undertake with general anesthesia. This patient was operated for incarcerated inguinal hernia with incidental finding of right side type B1 polyorchidism. Both of the right side testes were atrophic and excision was done. CONCLUSION Patients who present at a late adulthood age with polyorchidism and undescended testis can be successfully treated with surgical removal of the atrophic supernumerary testes.
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Affiliation(s)
- Badhaasaa B Bayissa
- Haramaya University, College of Health and Medical Sciences, Department of Surgery, Ethiopia.
| | - Dhugasa Tesfaye
- Oromia Regional Health Bureau, Shambo General Hospital, Ethiopia
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Bhandarwar AH, Gandhi SS, Patel CB, Wagh AN, Gawli V, Jain NA. Triorchidism: Presenting as Undescended Testis in a Case of Indirect Inguinal Hernia. Clin Pract 2016; 6:786. [PMID: 27478577 PMCID: PMC4943097 DOI: 10.4081/cp.2016.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 11/23/2022] Open
Abstract
Triorchidism is the commonest variety of polyorchidism, an entity with more than two testis is an extremely rare congenital anomaly of the testis. Although excision of the abnormal testis is a safer alternative proposed, recent literature suggests more conservative approach in normal testes with watchful regular follow up to screen for malignancy. This case presented as a left inguinal swelling diagnosed as indirect left inguinal hernia. The left side testis was of smaller size (about half) with normal sperm count, morphology and motility. Intraoperatively indirect inguinal hernia was noted with supernumerary testis at deep ring in addition to normal left testis in left scrotal sac. The ectopic testis were small (2.5×2.5×1 cm) lacking epididymis and with short vas deferens. An evident normal semen analysis and varied anatomy, the decision for orchidectomy of ectopic testis was taken. The histopathological finding was consistent with arrest in germ cell development.
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Affiliation(s)
- Ajay H Bhandarwar
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Saurabh S Gandhi
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Chintan B Patel
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Amol N Wagh
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Virendra Gawli
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Nimesh A Jain
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
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Méndez-Gallart R, Estevez-Martínez E, Rodríguez-Barca P, García-Palacios M, Bautista-Casasnovas A. Incomplete unilateral polyorchidism (bilobed testicle) mimicking testicular tumour. J Pediatr Surg 2012; 47:2140-2. [PMID: 23164013 DOI: 10.1016/j.jpedsurg.2012.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/29/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
Incomplete polyorchidism (also called bilobed testicle) is an extremely uncommon congenital anomaly. Only 3 cases of bilobed testicle were previously reported in the available literature. We describe a case of a 4-year-old boy who presented with a 6-month history of an asymptomatic scrotal mass located in the upper pole of the left testicle mimicking testicular tumour. After partial orchiectomy, macroscopic and pathological examination of the lesion confirmed the diagnosis of normal testicular tissue.
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Affiliation(s)
- Roberto Méndez-Gallart
- Department of Pediatric Surgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela. A Coruña. Spain.
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Kajbafzadeh AM, Ghahestani SM, Zamani MM, Kajbafzadeh M, Kia MM. A Novel Approach in Eight Polyorchidism Cases: Vasoepidydimal or Epididymo-epididymal Approximation in Single Vas Deferens Duplicated Testis. Urology 2012; 79:1346-9. [DOI: 10.1016/j.urology.2012.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 01/12/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
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