Abstract
The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential association of TM with testicular malignancy in adulthood has led to controversy regarding management and follow-up. To determine the prognostic importance of TM in children in correlation to the risk of testicular malignancy or infertility and compare the differences between the paediatric and adult population. We performed a literature review of the Medline, Embase and Cochrane controlled trials databases until November 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement. Twenty-six publications were included in the analysis. During the follow-up of 595 children with TM only one patient with TM developed a testicular malignancy during puberty. In the other 594 no testicular malignancy was found, even in the presence of risk factors. In the adult population, an increased risk for testicular malignancy in the presence of TM was found in patients with history of cryptorchidism (6% vs 0%), testicular malignancy (22% vs 2%) or sub/infertility (11-23% vs 1.7%) compared to TM-free. The difference between paediatric and adult population might be explained by the short duration of follow-up, varying between six months and three years. With an average age at inclusion of 10 years and testicular malignancies are expected to develop from puberty on, testicular malignancies might not yet have developed. TM is a common incidental finding that does not seem to be associated with testicular malignancy during childhood, but in the presence of risk factors is associated with testicular malignancy in the adult population. Routine monthly self-examination of the testes is recommended in children with contributing risk factors from puberty onwards. When TM is still present during transition to adulthood a more intensive follow-up could be considered.
Highlights
IntroductionThe exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population
The clinical significance of testicular microlithiasis (TM) remains unclear, posing a strategic problem for clinicians
In adult men with a history of cryptorchidism (n Z 1455), an increased risk for testicular malignancy of 6% was found in patients presenting with the diagnosis of TM compared to 0% in the TM-free population [32,35]
Summary
The clinical significance of testicular microlithiasis (TM) remains unclear, posing a strategic problem for clinicians. The risk of bias assessment for the studies for the adult population was already performed within the included systematic reviews and meta-analyses. Of the fifteen included studies with a total of 595 patients with TM only one study reported the development of 1 testicular malignancy during follow-up. The systematic reviews and meta-analyses sub-divided the adult population into seven groups: asymptomatic, symptomatic, cryptorchidism, sub/infertility, unspecified, with testicular tumour, with a positive family history and a specific prospective cohort. In adult men with a history of cryptorchidism (n Z 1455), an increased risk for testicular malignancy of 6% was found in patients presenting with the diagnosis of TM compared to 0% in the TM-free population [32,35]. Two patients did not have known risk factors for testicular tumour, while the other patients had infertility, cryptorchidism, testicular tumour of testicular atrophy
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
