Orchialgia secondary to polyorchidism: a case report

Polyorchidism, defined by the presence of more than two testes, is a rare congenital condition with an unclear etiology. It is hypothesized that the abnormal division of the genital ridge in the fetal embryonic period is responsible for the development of one or more supernumerary testicles. Due to the rarity of polyorchidism and its wide range of clinical presentations, the management of polyorchidism is unclear. Although up to a third of patients have reported associated scrotal pain, most cases of polyorchidism present without symptoms and are discovered incidentally during the evaluation and treatment of other conditions. When rarely reported, polyorchidism typically presents as triorchidism. Because the optimal management of polyorchidism has not yet been established, this case report aims to demonstrate the importance of an individualized treatment plan tailored to each patient's clinical presentation and goals for treatment.

This case report describes an extremely rare case of chronic orchialgia secondary to polyorchidism with quadorchidism in a 30-year-old man with three separate left testicles drained by two epididymides coming off of the left spermatic cord, and a solitary right testicle. The patient's clinical presentation and desire for permanent sterilization guided his treatment plan.

Orchiectomy of the supernumerary testes completely resolved the patient's scrotal pain, however, counseling on fertility and testosterone deficiency is indicated prior to consideration of orchiectomy.