Triorchidism: a case report and review of similar conditions

Abstract

Polyorchidism is a rare anomaly, defined as the presence of more than two testicles with about 100 cases reported in the literature. The majority of cases were triorchidism with occasional bilateral duplication. We report the case of a 32-year-old man with polyorchidism, presenting with primary infertility with oligoasthenoteratozoospermia semen profile. Scrotal examination revealed two discrete ovoid nontender, firm, mobile lumps with testicular sensation in the right side of the scrotum. Ultrasonography and magnetic resonance imaging confirmed the presence of double testes with double separate epididymides sharing a common vas deferens in the right side of the scrotum. It demonstrated similar echo texture and vascular flow in both right-sided testicles although smaller in size than the left testis. The case was managed conservatively without surgical intervention with follow-up. Tracing of similar conditions in the literature was discussed.

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

“…[2,9] Although previous reports suggested that most patients with polyorchidism presented with painless testicular or groin masses, recent analyses revealed that cases were mainly encountered during evaluation for other symptoms, such as acute scrotal pain or infertility. [2,[4][5][6] Our case presented with a painless scrotal lump, whereas most cases in the literature were diagnosed during exploration for inguinal hernia (24%), undescended testis (22%), and testicular torsion (15%). [2] Only 7% presented with pain as the solitary symptom.…”

“…Although there are no clear guidelines to determine which cases can be followed conservatively, recent data support watchful waiting in the absence of concomitant abnormalities and if testicular malignancy can be ruled out safely. [2,[4][5][6] In contrast, surgical exploration has the advantage of fixing the testis to prevent torsion and making biopsy easier if indicated. [3,4,9,11] Further management depends on several factors, such as the position of the supernumerary testis [ie, orthotopic (scrotal) vs. ectopic (inguinal or abdominal)], the reproductive potential (whether it is attached to a draining epididymis and vas), its size and volume (normal or atrophic), the age of the patient (young or adult), and psychological aspects that are related to follow-up (ie, anxiety of the patient).…”

“…[2,[4][5][6] In contrast, surgical exploration has the advantage of fixing the testis to prevent torsion and making biopsy easier if indicated. [3,4,9,11] Further management depends on several factors, such as the position of the supernumerary testis [ie, orthotopic (scrotal) vs. ectopic (inguinal or abdominal)], the reproductive potential (whether it is attached to a draining epididymis and vas), its size and volume (normal or atrophic), the age of the patient (young or adult), and psychological aspects that are related to follow-up (ie, anxiety of the patient). [5] Because most reported cases are detected during surgery for other urogenital symptoms, the question arises of whether the supernumerary testis should be left in situ (with orchiopexy if needed), biopsied for histological examination or removed.…”

“…As in the present case, left triorchidism was the most frequent presentation (65%), and the majority of supernumerary testes were found in the scrotal region (66%), followed by inguinal (23%) and abdominal (9%) locations. [2,4,5] Thus, polyorchidism has no unique clinical presentation and should be considered in the differential diagnosis of any scrotal or inguinal mass or pain.…”

“…[2] Polyorchidism classification also shows considerable variation between reports. [2][3][4][5][6][7][8][9] Leung grouped these cases according to anatomical variations based on their possible embryological basis and whether they had a shared or distinct epididymis or vas. [7] Similarly, Singer et al [8] divided these cases according to anatomic and functional properties, such as having drainage to an epididymis and vas deferens, which is suggestive of reproductive function.…”