Identification of a duplicated undescended testicle (polyorchia): an unexpected benefit of laparoscopic localization

Polyorchidism is an uncommon anomaly resulting from transverse division of the embryonic genital ridge. Up to 50 percent of cases are associated with cryptorchidism. The present case describes a 6-year-old boy who was referred for evaluation of an undescended right testicle. Examination revealed compensatory hypertrophy of the left testis (2 cm length; 2 cc volume; volume twice normal for age). These measurements were consistent with the presence of monorchidism rather than cryptorchidism. Laparoscopy was performed to confirm the absence of the nonpalpable testicle and to localize any testicular remnants. Laparoscopic findings included a hypoplastic testicle at the mid lumbar it level (abdominal testis) and a second hypoplastic testicle just distal to the internal inguinal ring (inguinal testis). Both measured no more than 1 cm in greatest diameter and were excised laparoscopically. Histologic examination revealed two immature tests, with the abdominal testis demonstrating atrophy. It is well recognized that laparoscopy the high undescended testicle, or identification of testicular remnants. In addition, nonpalpable testicle assists in localization of the undescended testicle or identification of the testicular remnants. In addition,laparoscopic high ligation and division of the gonadal vessels can be performed in cases of the high undescended testicle. Moreover, as demonstrated here, laparoscopy may also allow identification of polyorchia, especially in cases where the proximal testicle is intraabdominal. Inguinal exploration alone may result in failure to recognize a higher duplicated gonad. Failure to recognize and excise the duplicated, potentially dysplastic testicle may place the child at risk for subsequent malignant degeneration.