Polyorchidism: A Review of the Literature and Case Report of a Third Testicle Presenting as an Inguinal Hernia.

ABSTRACT: Polyorchidism, a very rare congenital anomaly, refers to the presence of more than 2 testes. It is often associated with many other pathologies including cryptorchidism, varicocele, testicular malignancy, and inguinal hernias.In this report, we describe a 40-year-old man who presented with an intermittently painful left groin, initially appearing as inguinal hernia. On ultrasound examination, a supernumerary testes and epididymis were found in the inguinal canal. The testes appeared sonographically normal with no evidence of associated pathologies. There was no evidence of an inguinal hernia containing fat or bowel.Ultrasound is essential in first-line diagnosis and classification of polyorchidism. Color Doppler ultrasound and magnetic resonance imaging can be used to clarify findings if sonographic images are inconclusive. We also review relevant literature as it pertains to classification, embryology, and treatment options. Patient treatment is based on imaging findings; if associated pathologies or malignancy is suspected, aggressive treatment such as surgical excision may be necessary. Otherwise, conservative treatment may be all that is needed.

A Potential Link: Cross-fused Renal Ectopia With Concomitant Absent Left Testicle.

Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which both kidneys are located on a unilateral side of the retroperitoneal space. The ureter of the ectopic kidney is seen to pass over the midline to insert in its normal anatomic position. Frequently this anomaly goes undetected until there is radiologic screening for other purposes or when other genitourinary issues are investigated. Although frequently isolated, this condition has been reported to be associated with other congenital anomalies, genetic disorders, and various urogenital anomalies more than 50% of the time. However, we found no cases linking CFRE with a solitary testicle. This is a case of a 30-year-old man with left-to-right CFRE with concomitant absent left testicle and obstructing distal calculus.

Robotic simple prostatectomy: a consideration for large prostate adenomas.

BACKGROUND: The management of benign prostatic hyperplasia (BPH) has changed considerably over the last several decades. First line treatment of BPH and lower urinary tract symptoms (LUTS) with medical therapy has created a population of men with much larger prostate glands, many of whom require surgical intervention. Patients with prostate glands greater than 80 to 100 grams may be better managed surgically with a retropubic prostatectomy. We explore our experience with robotic assisted simple prostatectomy and review the relevant literature. DATABASE: The database reviewed includes our experience with seven patients undergoing robotic simple prostatectomy, and a comprehensive review of the previously published series of this procedure. In addition, the literature pertaining to a pure laparoscopic approach to simple prostatectomy is reviewed. CONCLUSION: Robotic experience and training has become a standard in resident training programs; while classic transurethral resection is being performed less for large prostate glands. The robotic approach to simple prostatectomy provides an excellent option for surgical treatment of very large prostate glands, providing patients acceptable results in terms of operative time, estimated blood loss, hospital stay and duration of Foley catheter.