From the Research
Management of extratesticular calcification in a teenage patient typically involves a conservative approach with regular monitoring through ultrasound examinations. The initial recommendation is to obtain a comprehensive scrotal ultrasound to characterize the calcification and rule out any concerning features. If the calcification is determined to be benign (such as scrotal pearls or calcification of the epididymis), no specific treatment is necessary. The patient should be followed with periodic ultrasound examinations every 6-12 months to monitor for any changes in size or characteristics. Pain management, if needed, can include over-the-counter analgesics such as ibuprofen 400-600mg every 6-8 hours as needed. Reassurance is an important aspect of management, as most extratesticular calcifications in adolescents are benign findings. If the calcification is associated with hydrocele or epididymitis, treating the underlying condition may be necessary. For hydrocele, observation is typically recommended as many resolve spontaneously, while epididymitis may require antibiotics such as doxycycline 100mg twice daily for 10-14 days. Surgical intervention is rarely needed unless there are concerning features suggesting malignancy, significant symptoms, or rapid growth. The benign nature of most extratesticular calcifications relates to their formation from inflammatory processes or minor trauma resulting in calcium deposition in scrotal structures outside the testicular parenchyma, as noted in a study on scrotal calcification 1. A more recent study on idiopathic scrotal calcinosis also supports a conservative approach, with surgical excision considered only for symptomatic cases or those with significant cosmetic concerns 2. In the context of testicular microlithiasis, which may be associated with extratesticular calcification, a study suggests that the presence of multiple laminated calcifications within seminiferous tubules may be a criterion for testicular microlithiasis, but this does not necessarily imply a need for aggressive management in asymptomatic teenagers 3. Given the variability in management practices for testicular conditions, as highlighted in a survey of clinical management practices for testicular microlithiasis 4, a conservative approach with regular monitoring is recommended to balance the risks of intervention with the low likelihood of malignancy or significant morbidity in most cases of extratesticular calcification in teenagers.