Polyorchidism in Children: Preserve, Fix, or Remove the Supernumerary Testis?

Polyorchidism is a rare congenital anomaly characterized by the presence of more than two testes.Although advances in imaging have improved recognition of supernumerary testes, their optimal management remains controversial, particularly in children.The central therapeutic dilemma is whether a supernumerary testis should be preserved, repositioned and fixed, observed, or removed.Management should be individualized according to testicular viability, morphology, vascularity, anatomical location, relationship with the epididymis and vas deferens, associated cryptorchidism, risk of torsion, oncological suspicion, and the feasibility of long-term surveillance.Available pediatric evidence remains limited and does not allow definitive conclusions regarding long-term malignancy risk, endocrine function, or fertility.In a viable, normal-appearing, and oncologically reassuring supernumerary testis, preservation may be considered when this can be achieved safely, whereas orchiectomy remains appropriate for nonviable, markedly atrophic, dysplastic, or suspicious gonads.Until stronger pediatric evidence and longer follow-up become available, careful anatomical assessment, structured surveillance, and individualized surgical judgment remain essential.