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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. P olyorchidism is an anomaly of the genitourinary tract, with almost 200 cases reported in the literature; it refers to the presence of more than two testes.1 This congenital anomaly typically causes no impairments, but it is frequently associated with maldescended testis, inguinal hernia and testicular torsion. Reports slso show an increased risk of testicular malignancy in the presence of polyorchidism.2 This paper presents a case of polyorchidism without any associated anomaly in a 23-year-old man. Case reportA 23-year-old man presented with a painless spherical mass in the left hemiscrotum (Fig. 1). He first noticed this scrotal mass at the age of 11. The patient had no other medical history and was otherwise asymptomatic. Physical examination and laboratory tests, including a spermiogram, failed to reveal any other pathological finding. Scrotal ultrasonography showed a normal testicular gland measuring 32 mm in length on the right side. On the left side, two separate glands measuring 28 mm and 18 mm in length, with identical echo texture, were noted. All three glands demonstrated a separate epididymis. Further evaluation with magnetic resonance imaging (MRI) confirmed the presence of a supernumerary testis in the left hemiscrotum. All three glands had the identical signal characteristics on T1 and T2 weighted images. Following intravenous gadolinium administration, no pathological contrast enhancement within the testes was present (Fig. 2, Fig. 3). On the basis of these imaging findings, a diagnosis of polyorchidism was made. Considering the increased risk of testicular malignancy, the patient was followed 4 times for the first year, 2 times for the second year and annually thereafter. DiscussionThe exact mechanism for occurence of polyorchidism is still not known. Several theories have been proposed, including peritoneal folding, segmentation of the primitive gonads longitudinal or transverse division of the genital ridge. 3In fetal life, at about 6 weeks of gestation, the primordial testis develops from the primitive genital ridge medial to the mesonephric ducts. The primordial testis takes shape and the epididymis with the vas deferens arise from the mesonephric duct at 8 weeks. 4 On the basis of embryologic development, Leung classified polyorchidism in...

Surgical treatment of female stress urinary incontinence (SUI) has become very pop- ular after respectable success with minimal invasive surgeries. This is the first report of long term vaginocutaneous fistula (VCF) plus inguinal abcess after tension-free vaginal tape (TVT). A 67 year-old woman with vaginal discharge lasting more than 3 years complained with a painful swelling in the left inguinal area for the last three months. She had a medical history of TVT sling procedure for SUI six years ago. She had no history of pelvic surgery, cancer treatment or pelvic irradiation before or after TVT sling. No urethrovaginal or vesicovaginal fistula was found in physical examination and cystocopy. MRI showed a vaginocutenaous fistula and inguinal abcess. This case highlights the need for a high index of suspicion for VCF after TVT.