IDENTIFICATION OF A DUPLICATED UNDESCENDED TESTICLE (POLYORCHIA) - ANUNEXPECTED BENEFIT OF LAPAROSCOPIC LOCALIZATION

Polyorchidism is an uncommon anomaly resulting from transverse divisio n of the embryonic genital ridge. Up to 50% of cases are associated wi th 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 consi stent with the presence of monorchidism rather than cryptorchidism. La paroscopy was performed to confirm the absence of the nonpalpable test icle and to localize any testicular remnants. Laparoscopic findings in cluded a hypoplastic testicle at the mid lumbar level (abdominal testi s) and a second hypoplastic testicle just distal to the internal ingui nal ring (inguinal testis). Both measured no more than 1 cm in greates t diameter and were excised laparoscopically. Histologic examination r evealed two immature tests, with the abdominal testis demonstrating at rophy. It is well recognized that laparoscopy for the undescended, non palpable testicle assists in localization of the undescended testicle, or identification of testicular remnants. In addition, laparoscopic h igh ligation and division of the gonadal vessels can be performed in c ases of the high undescended testicle. Moreover, as demonstrated here, laparoscopy may also allow identification of polyorchia, especially i n cases where the proximal testicle is intraabdominal. Inguinal explor ation alone may result in failure to recognize a higher duplicated gon ad. Failure to recognize and excise the duplicated, potentially dyspla stic testicle may place the child at risk for subsequent malignant deg eneration.