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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 670-671
Polyorchidism in a patient with azoospermia


Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

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Date of Web Publication8-Jul-2009
 

How to cite this article:
Ahmadnia H, Molaei M. Polyorchidism in a patient with azoospermia. Saudi J Kidney Dis Transpl 2009;20:670-1

How to cite this URL:
Ahmadnia H, Molaei M. Polyorchidism in a patient with azoospermia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Jun 2];20:670-1. Available from: http://www.sjkdt.org/text.asp?2009/20/4/670/53300
To the Editor,

Polyorchidism, defined as the presence of more than two testes, is rare and less than 100 cases are reported in medical literature. We report on a 25 years old man who presented with history of infertility, three years after his marriage. He had no history of genitourinary complaints. Physical examination showed both testes to be of normal size. Semen analysis showed azoo­spermia on three separate occasions. Hormonal studies were normal. A decision was made to perform a biopsy of the testes. At the time of operation, we incidentally found a mass in his inguinal canal [Figure 1]. Exploration of this mass revealed a third testis. This additional testis had complete duplication of epididymis and vas de­ferens (Type IV).

Biopsies were then performed on all the testes followed by orchiopexy, which was performed on the additional testis. Histopathology showed essentially normal spermatogenesis in both the scrotal testes and germinal aplasia in the third testis. Orchiectomy of the supernumerary testis was performed.

Polyorchidism is a rare congenital anomaly. Leung [1] in 1988 described the anatomical variation on the possible embryological basis [Figure 2]:

Type I: The supernumerary testis lacks an epi­didymis or vas and has got no attachment to the usual testis (division of genital ridge only).

Type II: The supernumerary testis drains into the epididymis of the usual testis and they share a common vas, (division of genital ridge occurs in the region where the primordial gonads are attached to the metanephric ducts, although the mesonephros and metanephric ducts are not di­vided, i.e. incomplete division).

Type III: The supernumerary testis has its own epididymis and both epididymis of the ipsilate­ral testes drain into one vas (complete trans­verse division of mesonephrons as well as ge­nital ridge).

Type IV: Complete duplication of testes, epidi­dymis and vas (vertical division of genital ridge and mesonephros). [1]

Type II is the most common type. Type II and Type III, together account for more than 90% of cases of polyorchidism. Singer [2] et al suggested an anatomical as well as functional classification of polyorchidism:

Type 1: Supernumerary testes attached to the draining epididymis and vas deferens with repro­ductive potential (Leung type II, III, IV)

Type 2: Testes with lack of such an attachment without having any reproductive potential (Leung type I).

Each of these two types are again subdivided into two groups, Group-A and Group-B, depen­ding upon their location in the scrotum (ortho­topic) or outside the scrotal sac (ectopic) res­pectively. [2]

Infertility (20%) is a common finding in poly­orchidism; 37% of these patients have tubular atrophy, sertoli cell pattern (without leydig cells) or lack spermatogenesis. [3] Pre-operative diagno­sis of polyorchidism is difficult because of its extreme rarity. There are characteristic ultraso­nographic features of polyorchidism, and diag­nosis is often made on the basis of ultrasono­graphy. Magnetic resonance imaging (MRI) can be used for confirmation but may be more help­ful in cases complicated by cryptorchidism or neoplasia. [4]

Some authors have suggested excision or bio­psy of the abnormal testes in the management of polyorchidism. Their reason for this idea is the rare association of polyorchidism with carcino­ma, although enough evidence is not available presently to support this suggestion. However, the frequent association of other congenital ano­malies suggests that surgical exploration with bio­psy and/or exision should be performed.

Recent data shows that, in asymptomatic and normal testes, avoidance of surgical exploration is the proper management and surgical explo­ration should be limited to symptomatic testes.

In normal testes, fixation is the choice. [5]

In the management of polyorchidism, patients are divided into two groups:

  1. Incidental finding of supernumerary testis during scrotal or inguinal exploration: In these cases, orchiopexy should be the initial treatment. If pathologic evaluation shows no spermatogenesis, orchiectomey should be done.
  2. Finding polyorchidism on clinic examination or imaging study, pre-operatively: In these cases, malignancy should be ruled out by physical examination, imaging study (MRI or ultrasonography), and tumor markers. If this evaluation shows no abnormality, sur­gical exploration is not necessary.


 
   References Top

1.Leung AK. Polyorchidism. Am Fam Physician 1988;38(3):153-6.  Back to cited text no. 1    
2.Singer BR, Donaldson JG, Jackson DS. Poly­orchidism: Functional classification and manage­ment strategy. Urology 1992;39(40):384-8.  Back to cited text no. 2    
3.Ozok G, Taneli C, Yazici M, Herek O, Gokdemir A. Polyorchidism: A case report and review of the literature. Eur J Pediatr Surg 1992;2:306-7.  Back to cited text no. 3    
4.John AB, Majid M, Slowstky-Christya, Fried K, Foresto C. Polyorchidism: Report of 3 cases and review of the literature. J Ultrasound Med 2003; 23:951-7.  Back to cited text no. 4    
5.Khetan N, Torkington J, Jamison MH. Poly­orchidism presenting as retractile testes. BJU Int 1999;83:524.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Hassan Ahmadnia
Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad
Iran
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PMID: 19587516

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