Polyorchidism

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Polyorchidism is the incidence of more than two testicles. It is a very rare congenital disorder, with fewer than 200 cases reported in medical literature.[1] Polyorchidism is generally diagnosed via an ultrasound examination of the testicles. The most common form is triorchidism, or tritestes, where three testicles are present. The condition is usually asymptomatic. A man who has polyorchidism is known as a polyorchid.

Classification[edit]

Ultrasound scan of Type A3 polyorchidism
Ultrasound scan showing a side view of Type A3 polyorchidism, with annotations showing the superior and inferior testes and the head and tail of the epididymis

Polyorchidism occurs in two primary forms: Type A and Type B.[1]

  • Type A: The supernumerary testicle is connected to a vas deferens. These testicles are usually reproductively functional. Type A is further subdivided into:
  • Type B: The supernumerary testicle is not connected to a vas deferens and is therefore not reproductively functional. Type B is further subdivided into:
    • Type B1: The supernumerary testicle has its own epididymis but is not connected to a vas deferens
    • Type B2: The supernumerary testicle consists only of testicular tissue.

Type A3 is the most common form of polyorchidism, and types A2 and A3 together account for more than 90% of cases.[2] In 65% of cases, the supernumerary testicle is found in the left scrotal sac.[1]

Numeric system[edit]

An older system of classification structures polyorchidism into similar types, but with no subdivision[2] between connected and disconnected testicles:

Complications[edit]

Most cases of polyorchidism are asymptomatic, and are discovered incidentally, in the course of treating another condition. In the majority of cases, the supernumerary testicle is found in the scrotum.[1]

However, polyorchidism can occur in conjunction with cryptorchidism, where the supernumerary testicle is undescended or found elsewhere in the body. These cases are associated with a significant increase in the incidence of testicular cancer: 0.004% for the general population vs 5.7% for a supernumerary testicle not found in the scrotum.[1]

Polyorchidism can also occur in conjunction with infertility, inguinal hernia, testicular torsion, epididymitis, hydrocele testis and varicocele.[3] However, it is not clear whether polyorchidism causes or aggravates these conditions, or whether the existence of these conditions leads sufferers to seek medical attention and thus become diagnosed with a previously undetected supernumerary testicle.

Management[edit]

Because polyorchidism is very uncommon, there is no standard treatment for the condition. Prior to advances in ultrasound technology, it was common practice to remove the supernumerary testicle.[2] Several cases have been described where routine follow-up examinations conducted over a period of years showed that the supernumerary testicle was stable.[1]

A meta-analysis in 2009 suggested removing non-scrotal supernumerary testicles because of the increased risk of cancer, and regular follow-up in the remaining cases to ensure that the supernumerary testicle remains stable.[1]

References[edit]

  1. ^ a b c d e f g Bergholz, R.; Wenke, K. (2009). "Polyorchidism: A Meta-Analysis". The Journal of Urology 182 (5): 2422–2427. doi:10.1016/j.juro.2009.07.063. PMID 19765760.  edit
  2. ^ a b c Leung, A. K. (1988). "Polyorchidism". American Fam Physician 38 (3): 153–156. 
  3. ^ Kundu, A; et al. Triorchidism : An Incidental Finding And Review Of Literature. Retrieved 2012-03-21.