Polyorchidism and torsion. A lesson from 2 cases

Area of Science:

• Urology
• Pediatric Surgery
• Reproductive Medicine

Background:

• Polyorchidism is a rare congenital anomaly where individuals possess more than two testes.
• The "bell clapper" deformity, characterized by abnormal testicular suspension, is frequently associated with undescended testes and increases torsion risk.
• Management strategies for polyorchidism, particularly regarding the contralateral gonad, are debated in current literature.

Observation:

• Two cases of polyorchidism with duplication of the left testis were presented.
• Both patients exhibited the "bell clapper" deformity in the segmented gonads.
• Associated anomalies included a large mesorchium and absent scrotal ligament in one case, and adhesion to the tunica vaginalis due to prior appendix testis torsion in the other.

Findings:

• Orchidopexy was performed on all testes deemed at risk for torsion.
• The study challenges the current literature by recommending mandatory scrotal exploration and fixation of the contralateral, seemingly normal gonad.
• This approach is advised even without clinical or ultrasound evidence of associated abnormalities or complications.

Implications:

• This approach may reduce the incidence of testicular torsion in patients with polyorchidism.
• It highlights the importance of thorough surgical evaluation beyond initial clinical presentation.
• The findings suggest a revised standard of care for managing polyorchidism, emphasizing prophylactic measures for all gonads.