Testicular microlithiasis is a condition characterized by the presence of small calcium deposits within the testicles. These tiny calcifications are often discovered incidentally during imaging examinations of the scrotum. While not causing symptoms on their own, their detection often leads to questions about their nature and potential implications.
What is Testicular Microlithiasis?
Testicular microlithiasis involves the formation of small calcifications within the testicular tissue. These deposits are usually less than 3 millimeters and are composed of hydroxyapatite with concentric rings of cellular debris, glycoprotein, and collagen. The condition can affect one or both testicles, with bilateral involvement occurring in approximately 80% of cases.
Detection typically occurs during a scrotal ultrasound, an imaging technique that uses high-frequency sound waves. On ultrasound, these calcifications appear as multiple small, bright foci that do not cast an acoustic shadow. Diagnosis is confirmed when five or more microliths are observed in at least one field of view, classifying it as classic testicular microlithiasis. It is often an incidental finding when an ultrasound is performed for other reasons, such as pain, swelling, or fertility concerns.
Does Testicular Microlithiasis Go Away?
Testicular microlithiasis does not resolve on its own. The tiny calcium deposits are usually permanent. Imaging reports and long-term studies suggest these microcalcifications remain stable over time, with little change in appearance or number.
While the calcifications persist, their presence often remains asymptomatic. A change in the number of microliths has been observed in some instances, but complete disappearance is not a common outcome. Even after treatments like chemotherapy for other conditions, testicular microcalcifications persist.
Management and Associated Conditions
The medical approach to testicular microlithiasis involves monitoring rather than active treatment, especially when it is an incidental finding without other symptoms. Current recommendations from major organizations, including the European Association of Urology, do not support routine ultrasound surveillance for patients with no other risk factors for testicular cancer. Instead, emphasis is placed on regular testicular self-examination.
Testicular microlithiasis has been associated with testicular cancer and, less commonly, infertility. While a direct causal link between microlithiasis alone and testicular cancer is debated, its presence alongside other risk factors, such as a history of undescended testicle, testicular atrophy, or a family history of testicular cancer, may increase the likelihood of concurrent testicular germ cell tumors. For individuals with these additional risk factors, a healthcare provider might suggest close follow-up, potentially including annual ultrasound examinations.
Studies have shown a correlation between testicular microlithiasis and impaired spermatogenesis, particularly in men with unexplained infertility. Men with unexplained infertility and microlithiasis may have smaller testicular volume, elevated follicle-stimulating hormone levels, and lower sperm count and motility. While the precise nature of this relationship is still being investigated, an individualized approach to management is recommended, considering factors like age, fertility goals, and other associated conditions. Individuals with testicular microlithiasis should seek medical advice if they notice any new symptoms, such as a lump, swelling, pain, or changes in testicular size or consistency.