title: [Significance and management of testicular microlithiasis].
abstract: OBJECTIVE
  Testicular microlithiasis is an infrequent urologic diagnosis of non well-known etiology; it has been observed in patients with infertility, testicular atrophy, chromosomopathies, etc., and it had been considered as a benign non progressive disease for a long time. Recent reports have shown its occasional association with malignant tumors. We look for evidences about the significance of testicular microlithiasis and its relationship with gonadal pathologies.
  
  
  METHODS
  We perform an electronic bibliographic search in both The Cochrane library and MEDLINE. We performed a manual search in the AUA Update Series, Current Opinion Urology, and bibliographic citations from selected studies. We report one case of bilateral testicular microlithiasis studied at our center which is illustrative. Most published articles are case reports with bibliographic review.
  
  
  RESULTS
  The real incidence is unknown, although depending on the series varies from 0.04% in autopsies to 18.1% in testicular ultrasound series. It is more frequent in chryptorchidism, infertility, varicocele, testicular torsion, brain and sympathetic nervous system calcifications, pseudohermaphroditism, Down's syndrome, Klinefelter and Carney, cystic fibrosis, germ cell tumors and carcinoma in situ. There are series which report testicular tumor up to 46% of patients with testicular microlithiasis. It has been described tumor development during follow-up of testicular microlithiasis between 15 months and 11 years, so that it is believed to be a predisposing factor, a possible indirect indicator of premalignant disease, or a tumor marker. It has been also described in normal testicles.
  
  
  CONCLUSIONS
  The presence of testicular microlithiasis and its association to both benign diseases and malignant tumors makes a careful evaluation and follow-up necessary, mainly in patients with chryptorchidism, infertility, testicular atrophy, and contralateral testicular tumor; it is recommended testicular ultrasound each semester/year, physical examination, and testicular markers determination; to proceed with testicular biopsy is reasonable in patients of high risk (focal unilateral microlithiasis without mass, or the aforementioned chryptorchidism, infertility, testicular atrophy, and testicular tumor).
authors.affiliation: Servicio de Urología, Hospital General Universitario Morales Meseguer, Hospital General Universitario de Murcia, España.
authors.forename: Pablo Luis
authors.initials: PL
authors.lastname: Guzmán Martínez-Valls
authors.forename: Gregorio
authors.initials: G
authors.lastname: Hita Villaplana
authors.forename: Tomás
authors.initials: T
authors.lastname: Fernández Aparicio
authors.forename: Bernardino
authors.initials: B
authors.lastname: Miñana López
authors.forename: Francisco
authors.initials: F
authors.lastname: Martínez Díaz
authors.forename: Fernando
authors.initials: F
authors.lastname: Sánchez Gascon
mesh_terms: D001706:Biopsy; D015897:Comorbidity; D005832:Genital Diseases, Male / Q000453:epidemiology; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology; D020347:Lithiasis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D013733:Testicular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D013736:Testicular Neoplasms / Q000453:epidemiology