Testicular microlithiasis: Is there an agreed protocol?

Abstract

This review addresses the issues on etiopathogenesis of testicular microlithiasis (TM), associated clinical entities, evaluation and follow-up of patients with TM. A literature search of Medline/PubMed was carried out using the keywords ‘testicular microlithiasis’ and ‘testicular calcifications’ for published data in English language on TM from 1970 to 2006. TM is an uncommon entity among adult males, resulting from intratubular calcifications. The reported incidence of TM is highly variable. With the increasing frequency of ultrasound examination in scrotal and testicular conditions and with the advent of high frequency transducers, TM is increasingly being reported. TM is associated with many benign and malignant conditions of testes but the possible association of TM with testicular cancer has been a matter of concern. Though a few sporadic cases of testicular malignancies have been reported, it is believed that a conservative approach is warranted in the absence of high risk factors, in view of the low risks for invasive cancers. There is no uniform protocol for the evaluation and follow-up of the patients with TM. Those with high risk factors like contralateral testicular tumour, chromosomal anomalies, gonadal dysgenesis, cryptorchidism and definite ultrasound pattern of TM should be advised to have further evaluation. Incidentally detected asymptomatic TM during ultrasound examination does not warrant aggressive measures and it can be followed with self examination.

Genes associated with testicular germ cell tumors and testicular dysgenesis in patients with testicular microlithiasis

“…The diagnostic criterion for TM was the detection of more than three inclusions (with a diameter of 1–3 mm) without acoustic shadowing in testicular parenchyma. 6 …”

Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study

“…Testicular microlithiasis (TM) is characterized by multiple, small, uniform-appearing echogenic foci of less than 3 mm without acoustic shadowing in the seminiferous tubules, which may be indicative of degeneration of the testicular parenchyma [ 11 , 12 ]. Several theories about the origin or causes of TM have been reported, however, the exact etiology of TM still remains unclear [ 13 ]. Previous studies have reported an association between TM and testicular germ cell tumors and/or carcinoma in situ [ 14 , 15 ].…”

Testicular microlithiasis in male infertility: prevalence, diagnosis and treatment algorithm

“…Известно, что микролиты могут формироваться одновременно в органах половой, дыхательной и нервной систем, что, возможно, связано с пока еще не установленными генетическими дефектами. Оказалось, что ТМ чаще наблюдают у физически менее активных и социально неблагополучных мужчин, а также среди тех, кто употребляет много картофельных чипсов и попкорна [10,11]. ТМ нередко сопровождает другие заболевания -крипторхизм, гипогонадизм, перекрут яичка, варикоцеле, гидроцеле, сперматоцеле, а также неходжкинские лимфомы, муковисцидоз, синдромы Клайнфельтера и Дауна [3,12,13], а анализ 17 публикаций позволил также сделать вывод о снижении фертильности при ТМ, что дало основание предположить наличие связи между ТМ и синдромом тестикулярной дисгенезии [11].…”