Testicular microlithiasis is a condition that, in most cases, is a benign and incidental finding. This article aims to clearly and comprehensively explain what it is, why it occurs, its relationship to cancer and fertility, and how it is managed, to help dispel fears and offer reliable guidance based on current scientific evidence.
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What is testicular microlithiasis?
Testicular microlithiasis is not a disease in itself, but rather a condition characterized by the presence of microcalcifications within the seminiferous tubules of the testicles. These crystals accumulate in the ducts where sperm are produced and are usually discovered incidentally.
Degrees
Testicular microlithiasis is classified according to the amount of microcalcifications observed on ultrasound to describe its extent.
Grade 1 or mild
It is defined by the presence of fewer than 5 microcalcifications per scan field in a single ultrasound image. These are isolated and infrequent findings.
Grade 2 or moderate
It is characterized by the presence of between 5 and 20 microcalcifications per field of examination. The density of calcifications is greater than in the mild stage.
Grade 3 or severe
At this stage, more than 20 microcalcifications are visible per scan field. When these calcifications are so numerous that they appear in all fields, saturating the image of the testicle, it is referred to as classic testicular microlithiasis, which is the most typical presentation and the one that receives the most clinical attention.
It is essential to understand that the degree of microlithiasis does not correlate directly with a higher risk of cancer in isolation, although a higher burden of microlithiasis usually entails more careful monitoring, especially if there are other risk factors.
What causes it?
The exact cause of the formation of these microcalcifications is not known with complete certainty, but it is believed to be a degenerative process within the seminiferous tubules.
Common causes
The most widely accepted theory is that microcalcifications result from the shedding and accumulation of cellular debris within the seminiferous tubules. The cells that nourish developing sperm are unable to eliminate this debris, which eventually calcifies, forming hydroxyapatite deposits. This process can be the consequence of previous testicular damage or a developmental disorder.
Factors riesgo
Testicular microlithiasis has been most frequently associated with certain conditions affecting the testicles, such as cryptorchidism, male infertility and subfertility, testicular atrophy, Klinefelter syndrome, and Down syndrome. testicular torsion or previous testicular trauma, varicocele, and testicular dysgenesis syndrome.
Difference between unilateral and bilateral microlithiasis
What if I have testicular microlithiasis: Symptoms and signs
The main characteristic of testicular microlithiasis is that it is asymptomatic.
- It doesn't hurt.
- It cannot be felt.
- They do not alter the size or shape of the testicles to the naked eye.
- They do not produce a feeling of heaviness.
Any symptoms such as pain, swelling, redness, or a palpable lump are not due to microlithiasis, but to another testicular condition. Therefore, the only indication of its presence is the usually incidental finding on ultrasound.
Testicular microlithiasis in children: What to expect?
In pediatrics, testicular microlithiasis is also an uncommon finding. The considerations are similar to those in adults; it is usually an incidental finding during ultrasound performed for other reasons, it is associated with other conditions such as those mentioned above, and periodic follow-up is recommended, especially if the child presents other risk factors, with a vigilant approach.
Testicular microlithiasis and cancer risk
Microlithiasis is not an independent risk factor; the presence of testicular microlithiasis does not increase the risk of developing testicular cancer beyond that of the general population. However, it is a risk marker when associated with other factors such as a personal history of testicular cancer, cryptorchidism, testicular atrophy, unexplained infertility or subfertility, testicular dysgenesis syndrome, and a family history of testicular cancer.
How is it detected?
The only way to detect testicular microlithiasis is through a scrotal ultrasound.
This is a painless, non-invasive test that does not use radiation, and since it does not produce symptoms, the diagnosis is almost always incidental during an ultrasound requested for testicular pain, swelling or increased volume, infertility study, palpation of a lump or nodule or follow-up of cryptorchidism.
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How to treat testicular microlithiasis?
There is no treatment to eliminate microcalcifications, nor is one needed. Management focuses on risk assessment and monitoring. Low-risk patients are advised to perform regular testicular self-exams and consult their doctor if they notice any changes. High-risk patients are advised to be closely monitored with regular physical examinations by a urologist, annual scrotal ultrasounds, and, in highly selected, high-risk cases, testicular biopsy to rule out the presence of germ cell neoplasia in situ.
The goal is not to treat microlithiasis, but to detect any possible tumor early in those patients who do have an increased risk.
Testicular microlithiasis and infertility, what is their relationship?
There is an epidemiological association, but the microcalcifications themselves do not obstruct the tubules or mechanically damage the sperm. Rather, both microlithiasis and infertility may be the result of a common underlying cause, and this underlying damage would be responsible for both the infertility and the accumulation of debris that forms the microcalcifications.
Testicular microlithiasis and sexuality: can it affect it?
No, testicular microlithiasis does not affect sexuality. It has no impact on erections, ejaculation, or libido, and it does not influence testosterone production. The only potential impact on sexuality could be psychological, stemming from the anxiety or fear generated by the diagnosis, especially due to confusion with cancer. Therefore, being well-informed and seeking a medical consultation is the best course of action.
How to care for testicular health: A guide of tips
Monthly testicular self-examination
Make it a habit to do this when the skin of your scrotum is more relaxed. Gently examine each testicle with both hands, rolling it between your thumb and forefinger to familiarize yourself with its usual size, shape, and consistency. The goal is to detect any new lumps, swelling, changes in size or consistency, or any feeling of heaviness.
Know your risk factors
Learn about your personal and family medical history. If you have a family history of conditions or problems, discuss this with your urologist to establish a personalized monitoring plan, beyond self-examination.
Consult a doctor if you have any questions.
If you notice anything unusual during your self-exam, or if you experience pain, discomfort, or swelling, consult a urologist. Most of the time it won't be anything serious, but it's best to have it checked. In the case of children, parents should be alert to any abnormalities and discuss them with their pediatrician.
Frequently Asked Questions (FAQs)
How dangerous is testicular microlithiasis?
On its own, in a healthy man without other risk factors, it is not dangerous at all. Its potential danger lies solely in the fact that, if the patient has other risk factors, it necessitates more careful monitoring to detect possible cancer early.
Can it disappear on its own?
Testicular microlithiasis is considered a permanent finding. Once formed, the microcalcifications do not usually disappear or are reabsorbed over time. Follow-up studies generally show that they persist, although their number may vary slightly.
Does testicular microlithiasis affect sperm?
Not directly. However, it is more common in men with infertility, because both microlithiasis and poor semen quality can be the result of the same underlying testicular problem.
What is the prognosis for microlithiasis?
The prognosis is excellent. The vast majority of men with microlithiasis will never develop testicular cancer. The long-term prognosis is the same as for any other man of his age, provided that self-examination recommendations are followed and other risk factors are controlled.
Does testicular microlithiasis affect testosterone?
No. Testosterone production occurs in the Leydig cells, which are located outside the seminiferous tubules, where the microcalcifications are found. Microlithiasis does not damage these cells or interfere with hormone production.
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Conclusion
Testicular microlithiasis is an ultrasound finding that, when properly understood, is no longer a cause for concern, as it is asymptomatic and mostly benign. The key to its management lies not in evaluating the patient's context to determine the course of action based on risk factors and achieve early diagnosis if necessary, but rather in providing information, responsible monitoring, and medical consultation—the best tools for living comfortably with this diagnosis.
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