title: Management and follow-up of pediatric asymptomatic testicular microlithiasis: are we doing it well?
abstract: OBJECTIVE
  To define timing and methods for a balanced follow-up of testicular microlithiasis (TM) in pediatric age.
  
  
  METHODS
  We retrospectively reviewed medical records of 21 pediatric asymptomatic patients (42 testicular units) diagnosed with TM and without associated risk factors. Microliths were found bilaterally on ultrasonography in all the patients. Distribution of microliths (focal or diffuse) inside the parenchyma was evaluated as well as its eventual variation over time. Every six months, each patient underwent clinical and ultrasonography evaluation, as well as serum chemistry markers (α-fetoprotein and β-human chorionic gonadotropin) measurement to detect potential malignancy. In the interval between the follow-ups, parents and/or patients themselves were asked to control eventual enlargement of the gonads or scrotal swelling. Testicular biopsy was not performed in any of our subjects.
  
  
  RESULTS
  Of 21 patients, 6 had unilateral undescended testis, 4 varicocele, and 1 patent processus vaginalis with scrotal swelling while 10 patients did not show associated anomalies. The distribution pattern of microliths on ultrasonography remained unchanged in all follow-ups in every patient, showing a predominance of diffuse pattern in the undescended testis series. Tumor markers remained within normal limits. In no subject, we observed a shift toward a malignant condition.
  
  
  CONCLUSIONS
  In the pediatric population with an incidentally diagnosed TM and without any associated risk factor, a slight follow-up is suggested, consisting of clinical evaluation every 6 months, without any justifiable recommendation to perform a testis biopsy and a measurement of serum tumor markers.
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children Hospital, Palidoro (Rome), Italy. massimiliano.silveri@gmail.com
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Silveri
authors.forename: Francesca
authors.initials: F
authors.lastname: Bassani
authors.forename: Mauro
authors.initials: M
authors.lastname: Colajacomo
authors.forename: Cinzia
authors.initials: C
authors.lastname: Orazi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Adorisio
mesh_terms: D000293:Adolescent; D058070:Asymptomatic Diseases / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D020347:Lithiasis / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D013733:Testicular Diseases / Q000175:diagnosis* / Q000628:therapy*