Management of supernumerary testis in an adult: case report and review

Abstract

Polyorchidism is a rare congenital anomaly. Approximately 100 cases have been published to date. We report a case of triorchidism in a 20-year-old man who presented to us with inguinal hernia. There is more than 30% incidence of histological abnormalities in polyorchid testes and 4-7% present with malignancy. The management of polyorchidism is controversial. Some authors prefer conservative approach to increase the chances of spermatogenesis and others suggest excision to prevent malignancy. In our case, a biopsy of the testes was performed and was found to be normal. This patient was placed on follow-up with regular self examination, six monthly clinical examination and yearly scrotal sonogram.

Male Genitourinary System

“…It has been seen on the right in up to 30% of cases and bilaterally in 4.3%. A scrotal location is most common (66-75% of cases), although an inguinal location occurs in about 20% and abdominal in less than 10% of patients (Bergholz and Wenke 2009;Nayak and Sreejayan 2011;Kumar et al 2012). The supernumerary testis is usually found superior to the normal testis, although it may also be seen distal to it or rarely at the same level (Bergholz and Wenke 2009).…”

“…Type 4, the least common type, is due to complete division of the genital ridge and mesonephroci duct. The supernumerary testis therefore has its own epididymis and vas deferens (Nayak and Sreejayan 2011;Kumar et al 2012). …”

“…Three primary classification systems have been proposed based on embryologic origin by Leung (1988 ; Table 115.1), reproductive potential of the supernumerary testicle by Singer et al (1992;Table 115.2), and more recently Bergholz and Wenke (2009;Table 115.3); see also Nayak and Sreejayan (2011) and Kumar et al (2012).…”

“…Some propose removing all supernumerary testicles due to the risk of malignancy, while others propose removing all testicles without reproductive potential (not connected to a vas deferens) and any abnormal-appearing testicle (Nayak and Sreejayan 2011). Bergholz and Wenke (2009) propose removing all nonscrotal supernumerary testicles.…”

Polyorchidism; unilateral, one atrophic undescended double testicles

“…[3] Rarely undescended testicle may occur with clinical findings with an inguinal hernia and supernumeric testicle torsion. [45] Although ultrasonography (USG) and magnetic resonance imaging (MRI) facilitate supernumerary testicle diagnosis, the majority are asymptomatic and incidentally determined during surgical exploration. Polyorchidism is associated up to 40% with undescended testicles.…”