Introduction

Polyorchidism is described as the presence of two or more testes. It is a rare anomaly with less than 100 cases reported in literature. It is commonly found on left side and can be associated with undescended testis, cryptorchidism, torsion and malignancy. Differential diagnosis includes spermatocele, hydrocele, epididymal cysts or aberrant epididymis. Ultrasound, MRI and histological examination are the modalities of investigations available.

Case Report

A 23 year old man was referred to the Urology clinic by his physician with complaints of swollen left testis. The patient s past medical history on direct questioning revealed that at the age of 4 years he was diagnosed to have an undescended testis. However the testis descended before his planned surgery. On examination, he was found to have discrete swellings of equal texture in the left hemiscrotum suggestive of two testes. The abdominal examination was unremarkable. The diagnosis was confirmed by an ultrasound scan. He further underwent an MRI scan (Figure 1 and 2) to support the diagnosis and to rule out testicular tumour. The patient was managed conservatively without any further interventions with the advice to report if he develops new symptoms.

Figure 1

Figure 2

Discussion

The management of polyorchidism has been debated in length in literature. The recent opinion has been growing in favour of conservative management relying on ultrasound and MRI imaging. (₁)

The MRI appearance of polyorchidism is typical signal characteristics of testicles. In uncomplicated cases MRI just confirms the information given by ultrasound. However it is more sensitive in diagnosing associated complications like tumour and cryptorchidism. (₂)

We suggest that such cases should be managed conservatively if there are no associated complications.

Acknowledgements