Males can have more than two testicles, a condition medically termed polyorchidism. This is a rare congenital anomaly where an individual is born with extra testicular tissue. Polyorchidism is a recognized medical phenomenon, with understanding advanced by diagnostic imaging and research.
Understanding Polyorchidism
Polyorchidism refers to the presence of one or more additional testicles. The most common form is triorchidism, involving three testicles, though rare cases of four or five have been reported.
The extra testicle is often located within the scrotum, which accounts for about 75-76% of cases. However, it can also be found in other areas, such as the inguinal canal, the retroperitoneum, or the abdominal cavity. The additional testicle may be fully formed, possessing its own epididymis and vas deferens (sperm transport structures). In other instances, it might be rudimentary, consisting only of testicular tissue without vas deferens connection, making it non-functional. The condition can occur on one side (unilateral), with the left side being more commonly affected (around 65% of cases), or on both sides (bilateral), though bilateral cases are much rarer.
How Polyorchidism Develops and Its Rarity
Polyorchidism’s precise origin is not fully understood, but it likely stems from an abnormal duplication of the primordial genital ridge during fetal development. This developmental anomaly occurs before the eighth week of gestation. This duplication may stem from an incomplete division of the genital ridge, either longitudinally or transversely, or from an abnormal migration of cells.
Polyorchidism is exceptionally rare, with fewer than 250 cases reported in medical literature (140-200 documented). This rarity means it affects approximately 1 in 50,000 to 1 in 250,000 males. It is frequently discovered incidentally during investigations for other conditions or routine examinations, as it often causes no symptoms.
Identifying Polyorchidism
Polyorchidism is frequently asymptomatic, meaning it causes no noticeable symptoms, and is often discovered by chance. Discovery can occur during a routine physical examination, self-examination, or during medical investigations for other conditions, such as an inguinal hernia or an undescended testicle. A palpable scrotal mass may also prompt evaluation.
Diagnosis primarily relies on physical examination and imaging. Ultrasound is the main diagnostic tool, being non-invasive and able to differentiate testicular tissue from other masses. An extra testicle typically appears as a solid nodule with echotexture and blood flow similar to normal testicles. If ultrasound findings are not definitive or for complex situations, MRI can confirm. MRI provides detailed images, showing the extra testicle with signal characteristics identical to a typical testicle.
Managing Polyorchidism and Potential Concerns
The management of polyorchidism involves addressing potential health implications, with the primary concerns being the risk of malignancy, torsion, and, less commonly, infertility. While the extra testicle may or may not be functionally capable of producing sperm, the main consideration is a slightly increased risk of developing testicular cancer, although the overall risk remains low. This risk is notably higher if the supernumerary testicle is located outside the scrotum, such as in the inguinal canal or abdomen.
Management strategies typically involve watchful waiting with regular follow-up examinations and ultrasound surveillance. This approach allows healthcare providers to monitor for any changes in the size or characteristics of the extra testicle that might suggest tumor development or other complications. Surgical removal, known as orchiectomy, of the supernumerary testicle may be considered in specific circumstances. These include cases where the extra testicle is rudimentary, dysfunctional, or if there is a heightened suspicion of malignancy, especially if it is undescended or located outside the scrotum. The decision for surgical intervention versus observation is individualized, taking into account the specific features of the extra testicle, its location, and the patient’s overall health and preferences.