Testicular Microlithiasis: Patient Compliance in a Two-Year Follow-Up Program

Abstract

Introduction: We present a retrospective 2-year follow-up cohort of 103 men with testicular microlithiasis (TML) and discuss patient compliance and the value of surveillance.

Methods: A retrospective analysis of patients examined with scrotal ultrasonography (US) in the period from 2008 through 2010 was performed. A total of 103 men with TML were diagnosed and offered US follow-up every 6 months for 2 years. They were retrospectively analyzed regarding demographics and follow-up details, including the development of any kind of malignancy until March 2015, using the Danish Electronic Pathology Registry.

Results: The prevalence of TML was 10.3%. Of the 103 men with TML, 23 (22.3%) had TML in the left testicle, 38 (36.9%) in the right (p=0.002), and 42 (40.8%) had bilateral TML. Patient compliance was low with 11.7% participating in all US follow-up examinations. 5 men presented risk factors (testicular atrophy (N=1) and previous testicular cancer (N=4)), but no cases of testicular malignancy were found in the follow-up period.

Conclusion: The low patient compliance conflicts with the ESUR Scrotal Imaging Subcommittee guidelines that recommend scrotal US follow-up annually for TML until the age of 55 years. The fact that no cancers were found during follow-up using the pathology registry calls the value of follow-up into question.

Key words

testicular microlithiasis - testis cancer - prevalence - follow-up

• References

• 1 Wang T, Liu L, Luo J et al. A meta-analysis of the relationship between testicular microlithiasis and incidence of testicular cancer. Urol J 2015; 12: 2057-2064
• 2 Derogee M, Bevers RFM, Prins HJ et al. Testicular microlithiasis, a premalignant condition: prevalence, histopathologic findings, and relation to testicular tumor. Urology 2001; 57: 1133-1137
• 3 Sakamoto H, Shichizyou T, Saito K et al. Testicular microlithiasis identified ultrasonographically in Japanese adult patients: prevalence and associated conditions. Urology 2006; 68: 636-641
• 4 Thomas D, Vlachopapadopoulou E, Papadakis V et al. Testicular microlithiasis in siblings: clinical implications. Pediatr Radiol 2008; 38: 688-690
• 5 Costabile RA. How worrisome is testicular microlithiasis?. Curr Opin Urol 2007; 17: 419-423
• 6 Goede J, Hack WWM, van der Voort-Doedens LM et al. Prevalence of testicular microlithiasis in asymptomatic males 0 to 19 years old. J Urol 2009; 182: 1516-1520
• 7 Richenberg J, Belfield J, Ramchandani P et al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol 2015; 25: 323-330
• 8 DeCastro BJ, Peterson AC, Costabile RA. A 5-year followup study of asymptomatic men with testicular microlithiasis. J Urol 2008; 179: 1420-1423
• 9 Patel KV, Navaratne S, Bartlett E et al. Testicular Microlithiasis : Is sonographic surveillance necessary? Single centre 14 year experience in 442 patients with testicular microlithiasis. Ultraschall Med 2016; 37: 68-73
• 10 Richenberg J, Brejt N. Testicular microlithiasis: Is there a need for surveillance in the absence of other risk factors?. Eur Radiol 2012; 22: 2540-2546
• 11 Sharmeen F, Rosenthal MH, Wood MJ et al. Relationship between the pathologic subtype/initial stage and microliths in testicular germ cell tumors. J Ultrasound Med 2015; 34: 1977-1982
• 12 Cast JE, Nelson WM, Early AS et al. Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR 2000; 175: 1703-1706
• 13 Peterson AC, Bauman JM, Light DE et al. The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 2001; 166: 2061-2064
• 14 Bach AM, Hann LE, Hadar O et al. Testicular microlithiasis: What is its association with testicular cancer?. Radiology 2001; 220: 70-75
• 15 Skyrme RJ, Fenn NJ, Jones AR et al. Testicular microlithiasis in a UK population: its incidence, associations and follow-up. BJU Int 2000; 86: 482-485
• 16 van Casteren NJ, Looijenga LH, Dohle GR. Testicular microlithiasis and carcinoma in situ overview and proposed clinical guideline. Int J Androl 2009; 32: 279-287
• 17 Sanli O, Kadioglu A, Atar M et al. Grading of classical testicular microlithiasis has no effect on the prevalence of associated testicular tumors. Urol Int 2008; 80: 310-316
• 18 Middleton WD, Teefey SA, Santillan CS. Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology 2002; 224: 425-428
• 19 Korde LA, Premkumar A, Mueller C et al. Increased prevalence of testicular microlithiasis in men with familial testicular cancer and their relatives. Br J Cancer 2008; 99: 1748-1753
• 20 Vachon L, Fareau GE, Wilson MG et al. Testicular microlithiasis in patients with down syndrome. J Pediatr 2006; 149: 233-236
• 21 Lam DL, Gerscovich EO, Kuo MC et al. Testicular Microlithiasis. J Ultrasound Med 2007; 26: 867-873