Testicular microlithiasis: Is there an agreed protocol?

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.