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Erschienen in:
18.01.2024 | Case Report
Polyorchidism: A case of torsion of the third testicle
Erschienen in: Urologie in der Praxis | Ausgabe 1/2024
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Introduction
Polyorchidism means the presence of more than two testicles, which is a rare congenital anomaly of the genitourinary tract. Less than 200 cases have been reported in the literature. We report here a case of polyorchidism diagnosed following a testicular torsion.
Case presentation
An 11-year-old patient with a history of left retractile testis was admitted to our emergency department with acute left scrotal pain. On clinical examination, the scrotum showed slight redness on the left, significant swelling locally, and pain on palpation. An immediately performed beside-ultrasound showed a uniform left testicle of slightly smaller size than the right one, a decreased testicular vascularisation compared with the contralateral one, the presence of a large reactive hydrocele and a spermatic cord that looked twisted.
The patient underwent an emergency operation: scrotal exploration on the left side showed a torsion with two clockwise turns of a still viable testicle showing only slight signs of suffering. The patient underwent left testicular detorsion and bilateral testicular fixation. Examination at 2 weeksʼ follow-up suspected the presence of a supernumerary testicle on the left side. Control ultrasound confirmed the diagnosis of polyorchidism with the presence of two testicles on the left side.
Conclusion
Polyorchidism is rare but should be considered when assessing any additional scrotal mass. The recommended imaging is ultrasound or MRI. The management of uncomplicated polyorchidism is most commonly surveillance. In the case of torsion, detorsion and bilateral fixation of all testes should be performed. The recommendation is to preserve the supernumerary testicle if it is viable and without signs of malignancy. In cases of persistent fertility after vasectomy, polyorchidism should be excluded.