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[Unexplained male infertility and testicular microlithiasis]
P Turchi1, M L Sarteschi, R Benelli
1Servizio di Andrologia, UO di Urologia, Azienda USL 4 Prato.
Abstract:
In this study we analyse the frequency of testicular microlithiasis in a group of otherwise infertile healthy men, visited at the Andrology Service of Prato Hospital. Here the ultrasound machine is located in the ambulatory and it is possible to use it during the first visit of the patient, as we have done in 250 consecutive infertile men. This examination, easy and not invasive, has been performed to evaluate the pampiniform plexus to find possible varicocele, epydidimis for obstructive signs and testes for the presence or absence of parenchymal calcifications or masses. We found 106 positive sonographic records (42.4%) for scrotal diseases. Between them, two cases of testicular microlithiasis (0.8% of 250 consecutive ultrasound examinations and 1.7% in the last twelve months). Our data, although with a lower incidence than literature, show the importance of ultrasound examination in absence of specific diagnostic questions too, in the study of male infertility. Clinical management of testicular microlithiasis is difficult, due to loss of treatment and to cancer risk. A long term follow up is request, with periodical (6-12 months) sonographic controls. A classification (here we propose) can be useful for a more precise monitoring.
Insights
Testicular microlithiasis, a rare finding in infertile men, was identified in 0.8% of cases during routine ultrasounds. This highlights the importance of scrotal ultrasound in evaluating male infertility.
Area of Science:
- Andrology
- Radiology
- Urology
Background:
- Male infertility affects a significant portion of the population.
- Early detection of scrotal abnormalities is crucial for effective management.
- Testicular microlithiasis (TM) is a condition characterized by calcifications within the testes.
Observation:
- A study was conducted on 250 consecutive infertile men at the Andrology Service of Prato Hospital.
- Ultrasound examinations were performed during the initial patient visit to assess scrotal structures.
- The examination evaluated the pampiniform plexus, epididymis, and testes for abnormalities.
Findings:
- 106 positive sonographic records (42.4%) for scrotal diseases were identified.
- Two cases of testicular microlithiasis were detected, representing 0.8% of all examinations and 1.7% in the last twelve months.
- The incidence of TM in this cohort was lower than reported in existing literature.
Implications:
- The findings underscore the value of routine ultrasound in male infertility assessment, even without specific indications.
- Clinical management of TM is challenging due to treatment uncertainties and potential cancer risk.
- A proposed classification system and long-term follow-up with periodical sonographic controls (6-12 months) are recommended for precise monitoring.