Clinical update on testicular microlithiasis

Testicular microlithiasis becomes a greater interdisciplinary issue among urologists, andrologists, gynecologists dedicated to reproductive medicine, pediatricians, radiologists and pathologists. Proposed management ranges from benign neglect, instructing self-examination over follow-up once, regular biannual follow-up including ultrasonography to bilateral testicular biopsy to rule out possible concomitant unclassified intratubular germ cell neoplasia (ITGCN) or future development of testicular cancer. The aim of this review is to present an overview of the current dilemma and summarize management trends based on the most recent data.

Testicular microlithiasis is not a premalignant condition but may accompany ITGCN or testicular cancer. The importance of ruling out ITGCN with testicular biopsy in high-risk men, such as in those with bilateral testicular microlithiasis, infertility, cryptorchidism, atrophic testes or contralateral testicular cancer, has been recently advocated.

Despite greater awareness of testicular microlithiasis, a clear definition is currently missing and the etiology is still obscure. This causes confusion in management and follow-up. Self-examination alone or in combination with testicular ultrasonography has been advised. Recently, a single set of biopsies in selected, high-risk groups has been proposed to rule out ITGCN without a need for further investigations apart from self-examination. However, the cost-effectiveness of such a strategy needs to be evaluated.