Beyond triorchidism: diagnostic pitfalls and an evidence-driven algorithm for pediatric supernumerary testes

Area of Science:

• Pediatric Urology
• Medical Imaging
• Congenital Anomalies

Background:

• Supernumerary testes (SNTs), also known as polyorchidism, represent a rare congenital anomaly in pediatric patients.
• These anomalies frequently occur with other urogenital malformations, necessitating comprehensive evaluation.

Purpose of the Study:

• To characterize the clinical and imaging features of pediatric SNTs.
• To assess the diagnostic performance and misdiagnosis rates of ultrasonography and MRI for SNTs.
• To identify factors influencing misdiagnosis and surgical decisions, and to propose an evidence-based management algorithm.

Main Methods:

• Retrospective review of pediatric cases from two tertiary centers.
• PRISMA-guided systematic review and pooled analysis of published literature (Jan 2000-Apr 2025).
• Data extraction included presentation, imaging, Bergholz classification, treatments, pathology, and factors affecting diagnosis and surgical decisions.

Main Results:

• A pooled analysis of 113 patients revealed SNTs are often left-sided and scrotal, with triorchidism being the most common type.
• Ultrasonography, the primary imaging modality, demonstrated a misdiagnosis rate of 22.22%, associated with younger age, extrascrotal location, and concomitant anomalies.
• Surgical intervention was linked to extrascrotal SNTs and complications, while conservative management was associated with increased use of imaging.

Conclusions:

• Pediatric SNTs are rare and frequently associated with urogenital malformations.
• Ultrasonography has limitations in diagnosing SNTs, particularly in specific patient subgroups.
• Conservative management is recommended unless malignancy is suspected; surgery is indicated for extrascrotal SNTs, cryptorchidism, torsion, or complications.