From the Guidelines
Bilateral testicular microlithiasis is a benign condition that does not require specific treatment, and the primary concern is its potential association with testicular cancer, although this risk is relatively low. The condition is characterized by small calcium deposits within the seminiferous tubules of both testicles, typically detected incidentally during ultrasound examinations. The recommended workup includes:
- A thorough physical examination
- A scrotal ultrasound to confirm the diagnosis and rule out any concurrent testicular masses, as recommended by the American Urological Association 1. For patients with isolated testicular microlithiasis (without other risk factors), annual self-examinations are generally sufficient, as stated in the European Association of Urology guidelines 1. However, for those with additional risk factors such as cryptorchidism, infertility, family history of testicular cancer, or personal history of testicular cancer, more vigilant monitoring with annual ultrasound examinations is recommended, as suggested by the ESMO-EURACAN clinical practice guideline for diagnosis, treatment, and follow-up of testicular seminoma and non-seminoma 1. Patients should be educated about performing regular testicular self-examinations and reporting any changes promptly, as emphasized in the ACR Appropriateness Criteria for newly diagnosed palpable scrotal abnormality 1. The calcium deposits themselves don't require removal or specific medication. This approach is based on the understanding that while testicular microlithiasis may be associated with an increased risk of testicular cancer, most men with this condition never develop cancer, and unnecessary interventions should be avoided. It is essential to note that testicular microlithiasis in the absence of a solid mass or other risk factors for germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation or follow-up, as stated in the American Urological Association guideline 1 and the ACR Appropriateness Criteria 1.
From the Research
Definition and Overview of Testicular Microlithiasis
- Testicular microlithiasis refers to the presence of small, calcified deposits within the testicles, which can be detected through ultrasound imaging.
- The condition has been associated with an increased risk of testicular cancer, particularly in individuals with additional risk factors such as a history of testicular cancer, maldescent, or testicular atrophy 2, 3, 4.
Workup for Bilateral Testicular Microlithiasis
- The workup for bilateral testicular microlithiasis typically involves a thorough medical history and physical examination, as well as ultrasound imaging to confirm the presence of microlithiasis 4, 5.
- In individuals with additional risk factors, further evaluation may be necessary, including testicular biopsy to rule out underlying testicular cancer or intratubular germ cell neoplasia (ITGCN) 3, 6.
Treatment and Management
- The management of bilateral testicular microlithiasis depends on the presence of additional risk factors and the individual's overall risk of developing testicular cancer 2, 4, 6.
- In the absence of risk factors, routine surveillance or further intervention is not typically recommended, as the risk of developing testicular cancer is similar to that of the general population 2, 4, 5.
- In individuals with additional risk factors, regular follow-up with ultrasound imaging and/or testicular biopsy may be recommended to monitor for the development of testicular cancer 3, 4, 6.
- An individualized approach to management is recommended, taking into account the patient's age, fertility status, and other relevant factors 6.