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Background: Testicular microlithiasis (TM) is thought to be associated with testicular tumors and impaired spermatogenesis; however, its etiology remains unclear. Objectives: To identify factors, other than testicular function, that are associated with testicular microlithiasis. Materials and methods: We enrolled males who underwent ultrasound examination of the scrotum at Tokyo Dental College Ichikawa General Hospital. The patients were categorized into two groups: those with or those without testicular microlithiasis. Background and blood test data were compared between the groups. Results: Testicular microlithiasis was observed in 72 of the 828 (8.7%) patients enrolled. Ages ranged from 15 to 87 years (mean age, 40.0 years). A history of germ cell tumor was significantly more prevalent in patients with testicular microlithiasis than in those without (1.3 vs. 16.7%; p < 0.001). Blood test data showed that, patients with testicular microlithiasis had significantly higher serum creatinine levels (0.91 vs. 1.04 mg/dL; p = 0.046) and lower calcium levels (9.4 vs. 9.3 mg/dL; p = 0.031) than those without. Serum creatinine levels (> 1.00 mg/dL) and germ cell tumors were significantly associated with testicular microlithiasis in both univariate and multivariate analyses. The prevalence of testicular microlithiasis increased in patients older than 50 years. Age (> 50 years) was associated with testicular microlithiasis in univariate analysis. The mean body weight tended to be heavier (70.7 vs. 72.2 kg; p = 0.051) and epididymitis was observed more frequently (3.2 vs. 8.3%; p = 0.056) in patients with testicular microlithiasis than in those without. Discussion and conclusion: A history of testicular tumors and elevated serum creatinine levels were associated with testicular microlithiasis. Testicular microlithiasis was observed across all age groups, with a tendency to increase in patients older than 50 years. Patients with testicular microlithiasis were slightly heavier and had a higher prevalence of epididymitis than those without. Our findings suggest that, in addition to testicular dysgenesis, other factors are involved in the development of testicular microlithiasis. [ABSTRACT FROM AUTHOR]

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Over the years, the majority of scholars have done a lot of research on the theory of kidney storing essence in male infertility. However, most of them only pay attention to “essence” and ignore “storing”. The author believes that storing has two meanings, that is, hide too much and seal too little. Among them, the pathogenesis of blood stasis blocking collaterals has a great influence on “storing”. Male infertility is often related to the quality of male semen, but the etiology of Western medicine is not clear. The author starts from the perspective of “storing” in the theory of kidney storing essence, combines the pathogenesis of various modern andrology diseases and the pathogenesis of blood stasis blocking collaterals in traditional Chinese medicine, and takes testicular microlithiasis as the entry point, in order to explain the occurrence of male infertility from a new perspective and provide new ideas for the treatment of male infertility. [ABSTRACT FROM AUTHOR]

ABSTRACT Anatomical and ultrasonographic diagnostic work-up of testicular abscesses (n = 2) and testicular microlithiasis (n = 3) in Kazakh rams is described. For testicular abscesses, the localized symptoms include enlargement of the testicle and decreased elasticity, accompanied by varying degrees of pain and fever, abnormal behavior, walking or urinating with legs spread apart and accompanied by painful moans. Ultrasound findings: several hypoechoic or fluid dark areas with irregular morphology appear within the testicular parenchyma, with unclear borders with the surrounding normal tissues and uneven internal echogenicity. An autopsy revealed unilateral caseous necrosis with degeneration of all testicular tissues. Testicular microlithiasis does not present clinically and normal semen quality is not affected. Ultrasound findings: sparse, scattered, or dense punctate, pinpoint-like echogenic dots, some with comet tail signs and no acoustic shadow, are seen in the testicular parenchyma. The routine treatment for testicular abscesses is surgical drainage, but when degeneration and necrosis of testicular tissue occur, leading to severe systemic symptoms, the animal must be put down. Testicular microlithiasis is relatively rare and there are no effective treatments or interventions available, but it remains a potential contributor to testicular dysfunction and other secondary conditions.

Aim: To classify (etiologically) and to evaluate various scrotal pathologies using ultrasonography and describe the role of High resolution ultrasound and colour doppler in their diagnosis and differentiation. Methods: A prospective study was conducted in the Department of Radiology. The 100 patients with clinical features of scrotal diseases were include in this study. All the patients included in the study underwent scrotal ultrasonography using 7.0-12.0 MHZ high frequency linear array transducer coupled with Colour Doppler in Esaote My Lab 40 and Phillips affinti 70G equipments. Results: The patients most commonly involved were those belonging to the age group of 30 to 40 years (38%). The least number of patients belonged to the age group of 0-10 years (4%). On USG, the total number of lesions detected were 120. The most common cause of scrotal pathologies was hydrocele (n=31, 25.83%) followed by epididymal cyst (n= 20, 16.67%), epididymo-orchitis (n =16, 13.33%), epididymitis (n = 9; 7.5%), funiculitis (n=8, 6.67%), varicocele (n = 7, 5.83%), pyocele (n= 6, 5%), testicular torsion (n=5, 4.17%), testicular abscess (n = 5, 4.17%), inguino-scrotal hernia (n = 4, 3.33%), testicular microlithiasis (n= 3, 2.5%), testicular tumour (n=3, 2.5%) and tubercular epididymo-orchitis (n=3, 2.5%). The number of scrotal lesions seen on the left side were 45(37.5%), on the right side were 35 (29.17%) and in bilateral locations were 20(16.67%). Associated symptoms included swelling, pain, fever and infertility. Almost all the scrotal pathologies were associated with scrotal swelling (n=97, 97%) except in 3 cases. Epididymal cysts were seen in 20 patients, Acute epididymo-orchitis(n=16) was most commonly seen on the left side. Hydrocele (n=31) was the most common scrotal pathology detected in this study. Varicocele 7 patients was most commonly seen on the left side. Testicular torsion was detected in 5 (n = 5) patients. 3 (n=3, 60%) patients had right testicular torsion. Conclusion: High frequency ultrasonography with Color Doppler study serves as an excellent diagnostic imaging modality in the evaluation of scrotal diseases. It is the investigation of choice since it is highly sensitive, easy to perform, widely available, repeatable and involves no risk of ionizing radiation. Periodic follow-up USG scans are recommended for patients with inflammatory scrotal lesions to monitor response to treatment and to reveal the development of complications. [ABSTRACT FROM AUTHOR]

Objective: A potential relationship between testicular microlithiasis (TM) and testicular atrophy in childhood might increase the risk of testicular malignancy and infertility in adulthood. The present study aimed to determine the effect of the presence of TM on testicular volume by comparing the ultrasound-based testicular volumes between boys with TM and controls. Method: A total of 140 boys (mean +- standard deviation, 9.86 years +- 5.44 years; age range, 0-18 years) with two descended testes were classified into a study group of 70 patients with TM (TM group) and an age-matched control group of 70 boys without TM (non-TM group). The TM group was subdivided based on the number of microliths in one transducer field as ‘mild TM' (5-20 microliths) and ‘severe TM' (>20 microliths). The ultrasound-based testicular volume (mL) was estimated by the Lambert equation as 0.71× length × width × depth. Results: The average testicular volume in the TM group was 1.44 (0.70-4.68) mL and 3.09 (0.84-14.65) mL in the non-TM group. A lower testicular volume was observed in patients with TM, however, this difference was not significant (p=0.096). The average testicular volumes in patients with ‘severe TM' and ‘mild TM' were not significantly different (p=0.106). A lower testicular volume was found in older boys (≥15 years) with ‘severe TM'. Conclusion: We found no significant association in the testicular volume between boys with TM and controls, however, a lower testicular volume was observed in boys with TM. Thus, a close clinical follow-up might be considered in these patients.

To present the results of testicular ultrasonography supported by clinical and hormonal aspects in paediatric patients with Klinefelter syndrome (KS). Prospective analysis of medical files of 20 patients diagnosed with KS between 2016 and 2022. Assessed data included analysis of causes of referral, ultrasound, and clinical characterisation with hormonal evaluation of serum FSH, LH, testosterone, inhibin B, and anti-Müllerian hormone. Non-mosaic Klinefelter syndrome (47, XXY) was diagnosed in 65% of cases (13/20) by the geneticist (including 7 cases prenatally), in 25% (5/20) by the endocrinologist and in 10% (2/20) by the hematologist. Ultrasound assessment revealed bilateral testicular microlithiasis (TM) in all patients. The youngest KS patient with TM was 3 months old. TM patterns have not changed during follow-ups of up to 6 years in any of the patients. In all KS patients markedly reduced echogenicity and in pubertal KS patients, also irregular echostructure of the testes was observed. The hormonal patterns observed in the study group were typical for those already described in KS. Sertoli and Leydig cell function was intact in prepubertal patients and deteriorated after the start of puberty. Conclusion: Although the degenerative process in the testicular tissue starts very early in the testes in KS and is reflected in morphological changes seen in ultrasonography, Sertoli and Leydig cell hormonal function is normal in prepubertal KS patients. What is Known: • So far, normal Leydig and Sertoli cell function was observed in infants and prepubertal KS patients. What is New: • The morphological changes in the testes in KS may already be seen in early infancy. [ABSTRACT FROM AUTHOR]

Objective To explore the preliminary application and diagnostic value of virtual touch tissue imaging quantification (VTIQ) in testis. Methods Fifty male examiners in our hospital from June 2019 to March 2020 were selected as the research objects. According to whether the subjects suffered from testicular microlithiasis, they were divided into two groups such as the normal group and testicular microlithiasis group. The difference of obtained shear wave velocity was compared between the two groups, and the feasibility of acoustic palpation tissue imaging quantitative technology in normal testis and abnormal testis were analyzed. Results The measurement of different positions in the testis affected the magnitude of the shear wave velocity (P < 0. 05). The shear wave velocity of abnormal testis was obviously different from that of normal testis. At the same time, changes in position had a certain impact on the shear wave velocity of both testes (P < 0. 05). Conclusion The quantitative technique of acoustic palpation tissue imaging can be applied to the diagnosis of male testis and testis-related diseases, and it can provide a certain imaging basis for clinical diagnosis and treatment options. [ABSTRACT FROM AUTHOR]

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 works published in the II quarter (April – June) of 2021 was formed. The review includes articles on the following issues: the effectiveness of repeated micro-TESE in non-obstructive azoospermia, the role of COVID-19 in male fertility, the effect of testosterone therapy on spermatogenesis, testicular microlithiasis, electroejaculation as a method of obtaining spermatozoa, harm from carrying cell phones near the genitals, prediction of the effectiveness of intrauterine insemination, the effect of advanced paternal age on sperm aneuploidy, and the importance of the microbiome for male fertility.

Abstract Background Testicular microlithiasis in children was defined for the first time in 1961 based on histological criteria. There should be more than 5 calcifications per testicle in order to say that the patient has testicular microlithiasis. It has three different echographic grades depending on the number of calcifications. However, this disease is uncommon, with inaccurate prevalence and no certain information about its evolution or etiology. Main body We studied 4 clinical cases of children diagnosed with testicular microlithiasis, in light of the conducted review of the literature, and we defined the characteristics of this disease and proposed a management and monitoring framework based on the clinical observations. Conclusion There is a link between testicular microlithiasis and testicular cancer. Therefore, it is recommended to make a regular follow-up of children who present testicular microlithiasis with the presence of risk factors.

Abstract Objective To investigate the anogenital distance in patients with and without testicular microlithiasis (TML). Methods A total of 101 patients underwent a conventional standard clinical B-mode scrotal ultrasonography and scrotal MRI. The patients were divided into two groups: patients with TML and non-TML. The latter served as control group. The anogenital distance was measured by a straight line from center of the anus to the posterior base of scrotum using MRI. Results In the TML group, mean AGD was 5.4 (± 1.07) cm (range 29–79 mm), and in non-TML 5.9 (± 1.03) cm (range 35–85 mm) (p = 0.04). Conclusion MRI is a useful tool to measure the AGD. It is easy to perform without any discomfort to patients. We found AGD to be lower in patients with TML.

Objective: To investigate the prevalence of testicular microlithiasis and its association with sperm retrieval rates and histopathology in men with non‐obstructive azoospermia. Methods: A total of 120 men underwent scrotal ultrasonography prior to microsurgical testicular sperm extraction. Sperm retrieval rate, testicular histopathology, testicular size, reproductive hormones, karyotyping, Y chromosome microdeletion analyses, and presence of varicoceles and hydroceles were compared between men with and without testicular microlithiasis. Results: The total sperm retrieval rate was 40%. Ten men with normal spermatogenesis were excluded. The remaining 110 men with non‐obstructive azoospermia were analyzed and testicular microlithiasis was detected in 16 of them (14.5%). The sperm retrieval rate in that subgroup was only 6.2% (1/16) as opposed to 39.4% (37/94) in men with non‐obstructive azoospermia and no evidence of microlithiasis (P = 0.009). The mean right and left testicular diameters were significantly lower in the microlithiasis group (P = 0.04). On multivariate logistic regression analysis, the presence of mictolithiasis (odds ratio 7.4, 95% confidence interval 2.3, 12.2; P = 0.01) was the only independent predictor of unsuccessful sperm retrieval. The 15 patients with microlithiasis and without successful sperm extraction were diagnosed by histopathology as having Sertoli cells only. The 16th patient with successful sperm retrieval had a histopathology of mixed atrophy and was diagnosed with Klinefelter syndrome. Conclusion: The presence of testicular microlithiasis is associated with low sperm retrieval rates among our cohort of men with non‐obstructive azoospermia undergoing scrotal ultrasonography prior to microsurgical testicular sperm extraction. Larger, prospective studies should be conducted to confirm these findings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the association of testicular pathologies with TM.Method: The retrospective study included pediatric patients who underwent scrotal ultrasonography (US) due to complaints, including testicular pain, discomfort, swelling, scrotal redness in our clinic between June 2020 and January 2022. The patients were divided into two groups. Group 1; patients were diagnosed with testicular pathology or presented with testicular pain. Group 2; patients without testicular pathology or complaints. Patients were also classified as having undescended testis, epididymo-orchitis, varicocele and testicular pain without testicular pathology in group 1. Group 1 and subgroups of group 1 were compared with group 2 for the presence of TM.Results: A total of 516 patients were included in the study. Median age at the time of US examination was 24 months (range 1 month-17 years). There was no significant difference between groups 1 and 2, and boys with undescended testis and group 2 with regard to the presence of TM (p = 0.85, p = 0.55, respectively). TM was significantly higher in patients who had undergone orchiopexy and presented with testicular pain compared to group 2 (p = 0. 013, p = 0.03, respectively). TM was not detected in patients with epididymo-orchitis, varicocele.Conclusion: We found no association between TM and testicular pathologies. Testicular pain may be a symptom of microlithiasis. [ABSTRACT FROM AUTHOR]

A 26-year-old patient with cryptozoospermia turned to the International Center for Reproductive Medicine for infertility. The man underwent surgical treatment for right-sided cryptorchidism in childhood. Subsequently, he was repeatedly examined and treated for scrotal pain. An ultrasound examination of the scrotum revealed bilateral testicular microlithiasis and signs of neoplasm of the left testicle that was not detected by palpation. Based on the research data, the patient underwent left orchifuniculectomy. Based on a histological examination, the diagnosis was established: a mixed germ cell tumor seminoma and teratoma against the background of intratubular germ cell neoplasia. A case from practice allows us to justify the expansion of indications for ultrasound of the scrotum in the non-inflammatory chronic pelvic pain syndrome (scrotal pain).

Objective: To investigate the anogenital distance in patients with and without testicular microlithiasis (TML). Methods: A total of 101 patients underwent a conventional standard clinical B-mode scrotal ultrasonography and scrotal MRI. The patients were divided into two groups: patients with TML and non-TML. The latter served as control group. The anogenital distance was measured by a straight line from center of the anus to the posterior base of scrotum using MRI. Results: In the TML group, mean AGD was 5.4 (± 1.07) cm (range 29–79 mm), and in non-TML 5.9 (± 1.03) cm (range 35–85 mm) (p = 0.04). Conclusion: MRI is a useful tool to measure the AGD. It is easy to perform without any discomfort to patients. We found AGD to be lower in patients with TML. [ABSTRACT FROM AUTHOR]

Study Question: Is there an association of testicular microlithiasis (TM) and its severity with testicular dysfunction in men from infertile couples?Summary Answer: The presence of ≥5 testis microcalcifications per sonogram at the scrotal ultrasonography (US) of infertile males was associated with a more severe testicular dysfunction as compared to males with limited, or without, TM.What Is Known Already: TM, representing an incidental finding in the scrotal US, is associated with male infertility and a higher risk for testicular cancer as compared to that in infertile males without TM. Still, there are unresolved questions on the relation between TM severity and testicular dysfunction in infertile men, as well as on the identification of risk factors for TM.Study Design, Size, Duration: This study was an observational, retrospective, case-control investigation involving males who underwent clinical evaluation, measurement of reproductive hormones, seminal analysis and scrotal US as part of diagnostic work-up for couple infertility at an andrology clinic, between January 2004 and December 2018. One hundred patients, out of the 2112 scored men, were found to have TM during the US evaluation. One hundred male partners from 100 infertile couples without TM, comprising the control group, were selected through a matched analysis by age and date of evaluation to reduce the confounding effect of both age and technique variability all along the long period of observation.Participants/materials, Setting, Methods: TM was defined as limited TM (LTM) or classical TM (CTM), when the maximum number of hyperecogenic spots per sonogram was <5 or ≥5, respectively. CTM, LTM and control groups were compared for clinical variables, serum levels of FSH, LH, and total testosterone, as well for semen parameters and scrotal US features.Main Results and the Role Of Chance: After the exclusion of cases with testicular nodules to eliminate the possible confounding effect of testis cancer on testicular dysfunction, cases with CTM showed a lower mean testis volume (P = 0.03) and a lower sperm concentration (P = 0.03) as compared to the other two groups. A higher FSH level was observed in the CTM group compared to the LTM group (P = 0.02) and in controls (P = 0.009). The multiple logistic regression analysis showed that only a smaller testicle volume exhibited an independent significant association with a higher odds of detecting CTM (odds ratio = 0.84, 95% CI: 0.75-0.94; P = 0.02). No significant differences were observed between groups in the prevalence of risk factors for testicular cancer, or in the prevalence of conditions associated with TM.Limitations, Reasons For Caution: The retrospective design of the study did not allow conclusions to be drawn about the possible underlying links in the associations of TM with defective spermatogenesis.Wider Implications Of the Findings: Males from infertile couples who exhibit a reduced testicular volume should undergo scrotal US, independent of sperm parameters, to exclude CTM and, eventually, testis cancer, although the association of CTM and current or future testis cancer risk is not yet clear. Evidence is provided here demonstrating that the presence of LTM has no clinical relevance in males from infertile couples.Study Funding/competing Interest(s): Investigation was funded by Ministero dell'Università e della Ricerca, PRIN 2018, Italy. The authors have not declared any competing interests.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Introduction: Testicular microlithiasis (TM) is a rare disease in the pediatric population. A possible link with testicular tumors (TC) requires appropriate attention to the disease. The paper describes in multiple case reports our personal experiences with this disease. Materials and Methods: TM were found in 5 patients during screening ultrasound (USG) examination of the testes performed due to other pathologies of the scrotum (hydrocele, testicular retention, varicocele) or positivity in the family history of TC in the years 2010-2020. The age of the patients at the time of diagnosis was 18-155 months (average = 98, median = 126 months). All of them had characteristic bilateral finding. At the same time there were diverse risk factors present in three patients (history of seminoma in the fathers of two patients, one patient after bilateral orchidopexy). Results: All 5 patients are routinely observed for 12-72 months (average = 50, median = 72 months), perform autopalpation of the testes once a month and undergo USG once a year. In 4 patients there were no changes in the sense of palpation or USG finding that would raise a suspicion of TC. In one patient a small cyst was described on the right testis during one of the control USG at another urology department. During USG at our department a contralateral multiple cystic formation of the epididymis - spermatocele - was found, howeve a cyst was not found in the right testicle. The usual standard procedure with autopalpation and USG controls followed. Conclusion: We observed three risk cases of TM with risk factors. Therefore all the patients are monitored not only by autopalpation monthly but also by USG annually. No patient has been indicated for biopsy or orchiectomy yet. For all of them, we expect transfer to subsequent transient care in adulthood. [ABSTRACT FROM AUTHOR]

Background: To systematically evaluate the incidence characteristics of testicular microlithiasis (TM) in children and its association with primary testicular tumors (PTT). Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered in the PROSPERO database (CRD42018111119), and a literature search of all relevant studies published until February 2019 was performed. Prospective, retrospective cohort, or cross-sectional studies containing ultrasonography (US) data on the incidence of TM or the association between TM and PTT were eligible for inclusion. Results: Of the 102 identified articles, 18 studies involving 58,195 children were included in the final analysis. The overall incidence of TM in children with additional risk factors for PTT was 2.7%. In children, the proportion of left TM in unilateral cases was 55.7%, the frequency of bilateral TM was 69.0%, and proportion of classic TM was 71.8% [95% confidence interval (CI) 62.4–81.1%, P = 0.0, I2 = 0.0%]. About 93.5% of TM remained unchanged, and newly detected PTT rate was very low (4/296) during follow-up. The overall risk ratio of TM in children with a concurrent diagnosis of PTT was 15.46 (95% CI 6.93–34.47, P < 0.00001). Conclusions: The incidence of TM in children is highly variable. Nonetheless, TM is usually bilateral, of the classic type, and remains stable or unchanged at follow-up. Pediatric patients with TM and contributing factors for PTT have an increased risk for PTT; however, there is no evidence to support mandatory US surveillance of children with TM. [ABSTRACT FROM AUTHOR]

Abstract Aim of this survey is to review the few available literature data on pathophysiologic and clinical aspects of pubertal development in boys with McCune-Albright syndrome (MAS). On the basis of such analysis, we concluded that: 1) peripheral precocious puberty (PPP) is significantly more infrequent in boys than in girls; 2) the most common testicular abnormality at MAS presentation is macroorchidism, that may be either monolateral or bilateral; 3) macroorchidism is not always associated with clinical and biochemical evidence of PPP; 4) testicular microlothiasis is distinctly more frequent in boys with MAS than in those without MAS; 5) the available therapeutic schedules have to be adopted already at MAS presentation only in the cases with PPP.

X-linked adrenal hypoplasia congenita (AHC) is a rare disorder that usually presents clinically as adrenal insufficiency in early infancy. It is caused by mutations in the NR0B1 gene which is located on the short arm of chromosome X (Xp21). The NR0B1 gene plays an important role in normal development and function of both the adrenal and gonadal axes and some patients with the disease can present in adolescence with hypogonadotropic hypogonadism. Testicular microlithiasis is an ultrasonographic finding of unknown etiology that has been associated with several benign conditions such as cryptorchidism, congenital adrenal hyperplasia, varicoceles, and testicular malignancy. We report the case of an 11-year-old boy who was diagnosed at the age of 8 months with X-linked AHC due to adrenal failure and presented testicular microlithiasis during follow-up. To the best of our knowledge, this is the first case of an X-linked AHC patient diagnosed with testicular microlithiasis in follow-up.

Résumé Introduction Il existe de nombreux articles sur les microlithiases testiculaires découvertes au cours d’une échographie. Nous voulions mettre à jour les données. Méthodes Pubmed a été utilisé pour identifier des articles originaux traitant de l’association entre les microlithiases testiculaires et les tumeurs testiculaires, de 1998 à mai 2017. Les études ont été incluses si les microlithiases étaient diagnostiquées par échographie. Les études ont été classées en sous-groupes selon certains critères (asymptomatiques, symptomatiques, infertilité, cryptorchidie, antécédents familiaux ou personnels de cancer des testicules, et « absence de motif pour la réalisation de l’échographie »). Nous avons utilisé un Z-test pour indiquer les différences au sein de ces groupes. De plus, nous avons identifié des cohortes prospectives de patients atteints de microlithiases testiculaires. Le nombre, la durée du suivi et la survenue de l’événement « tumeur testiculaire » ont été enregistrés pour chacun d’entre eux. Résultats Cent soixante-quinze articles ont été identifiés, dont 40 ont été inclus. Dans notre revue, il n’y a pas de lien évident pour que les microlithiases associées à la cryptorchidie soient un facteur de risque de tumeur testiculaire. Il semble y avoir une corrélation entre l’infertilité et les microlithiases avec un risque tumoral plus élevé. Il n’y avait pas assez d’études pour confirmer une relation entre les antécédents personnels ou familiaux associés aux microlithiases et le risque de tumeur. Il y avait aussi une corrélation avec un risque tumoral plus élevé pour les microlithiases dans le groupe symptomatique et le groupe « sans motif de réalisation de l’échographie ». Cependant, ces groupes sont supposés contenir des biais et des précautions doivent être prises en ce qui concerne les conclusions. En ce qui concerne les études de cohorte prospective, 16 tumeurs testiculaires sont apparues dans le suivi des patients atteints de microlithiases. Treize patients avaient des facteurs de risque. Conclusion En cas de découverte fortuite de microlithiases testiculaires à l’échographie associées à la présence de facteurs de risque (antécédents personnels de cancer des testicules, atrophie testiculaire, infertilité, cryptorchidie), une consultation avec un spécialiste doit être envisagée. En l’absence de facteurs de risque, la survenue d’un cancer du testicule chez les patients atteints de microlithiases est. similaire au risque pour la population générale. Mots-clés microlithiases testiculaires, tumeur testiculaire, cancer testiculaire, tumeur germinale, infertilité, échographie.

Abstract Background It has been described that the incidence of testicular microlithiasis is high in several congenital disorders which may be associated with testicular impairment and infertility. Several reports have shown that a prepubertal or pubertal hormonal abnormality in the pituitary-gonadal axis was identified in some patients with hypospadias that is one of the most common disorders of sex development. However, exact prevalence or risk factors of testicular microlithiasis in patients with hypospadias have not reported so far. In the present study, to clarify the prevalence and risk factors of testicular microlithiasis in patients with hypospadias, a retrospective chart review was performed. Methods Children with hypospadias who underwent testicular ultrasonography between January 2010 and April 2016 were enrolled in the present study. Severity of hypospadias was divided into mild and severe. The prevalence and risk factors of testicular microlithiasis or classic testicular microlithiasis were examined. Results Of 121 children, mild and severe hypospadias were identified in 66 and 55, respectively. Sixteen children had undescended testis. Median age at ultrasonography evaluation was 1.7 years old. Testicular microlithiasis and classic testicular microlithiasis were documented in 17 children (14.0%) and 8 (6.6%), respectively. Logistic regression analysis revealed that presence of undescended testis was only a significant factor for testicular microlithiasis and classic testicular microlithiasis. The prevalence of testicular microlithiasis or classic testicular microlithiasis was significantly higher in children with undescended testis compared to those without undescended testis (testicular microlithiasis; 43.8% versus 9.5% (p = 0.002), classic testicular microlithiasis; 37.5% versus 1.9% (p

Testicular microlithiasis (TM) is one of the symptoms of testicular dysgenesis syndrome (TDS). TM is particularly interesting as an informative marker of testicular germ cell tumors (TGCTs). KIT ligand gene (KITLG), BCL2 antagonist/killer 1 (BAK1), and sprouty RTK signaling antagonist 4 (SPRY4) genes are associated with a high risk of TGCTs, whereas bone morphogenetic protein 7 gene (BMP7), transforming growth factor beta receptor 3 gene (TGFBR3), and homeobox D cluster genes (HOXD) are related to TDS. Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis, we investigated allele and genotype frequencies for KITLG (rs995030, rs1508595), SPRY4 (rs4624820, rs6897876), BAK1 (rs210138), BMP7 (rs388286), TGFBR3 (rs12082710), and HOXD (rs17198432) in 142 TGCT patients, 137 TM patients, and 153 fertile men (control group). We found significant differences in the KITLG GG_rs995030 genotype in TM (P = 0.01) and TGCT patients (P = 0.0005) compared with the control. We also revealed strong associations between KITLG_rs1508595 and TM (G allele, P = 0.003; GG genotype, P = 0.01) and between KITLG_rs1508595 and TGCTs (G allele, P = 0.0001; GG genotype, P = 0.0007). Moreover, there was a significant difference in BMP7_rs388286 between the TGCT group and the control (T allele, P = 0.00004; TT genotype, P = 0.00006) and between the TM group and the control (T allele, P = 0.04). HOXD also demonstrated a strong association with TGCTs (rs17198432 A allele, P = 0.0001; AA genotype, P = 0.001). Furthermore, significant differences were found between the TGCT group and the control in the BAK1_rs210138 G allele (P = 0.03) and the GG genotype (P = 0.01). KITLG and BMP7 genes, associated with the development of TGCTs, may also be related to TM. In summary, the KITLG GG_rs995030, GG_rs1508595, BMP7 TT_rs388286, HOXD AA_rs17198432, and BAK1 GG_rs210138 genotypes were associated with a high risk of TGCT development.

Background: Testicular microlithiasis (TM) is sometimes found on scrotal ultrasound. The prevalence seems higher in populations of men with testicular dysfunction, and TM may be a risk factor for testicular germ cell neoplasia in situ in men with additional risk factors. The association between TM and testicular function is controversial, especially in incidentally found TM. Objectives: To determine the frequency of TM in young men from the general population, and associations between TM, semen quality, and reproductive hormones. Materials and methods: A cross‐sectional study of 4850 Danish men, median age 19 years. Testicular pattern, including the presence of TM, was assessed by ultrasound examination. Participants provided a questionnaire, one semen sample, and one blood sample. Semen variables and serum reproductive hormones were analyzed as outcomes using multivariable regression analysis to determine associations with TM. Results: TM was detected in 53 men (1%), of which 19 (36%) were unilateral and 34 (64%) were bilateral cases. A history of cryptorchidism was associated with presence of TM. Bilateral TM was associated with slightly lower testicular volume, sperm concentration, and total sperm count. TM was not significantly associated with serum testosterone or other reproductive hormones. Discussion and Conclusion: TM is rare in men from the general population and is associated with lower sperm count if bilateral, although effect sizes were small. Current European guidelines do not recommend any follow‐up in cases of TM with no other risk factors for testicular cancer. We suggest that men with incidentally found bilateral TM may be offered a semen analysis, but analysis of reproductive hormones seems unnecessary. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of testicular microlithiasis and the relationship between testicular microlithiasis, semen parameters and endocrinological profiles in healthy newlywed men trying for first-time pregnancy. Methods: Men visiting Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan, or D Clinic Tokyo, Chiyoda-ku, Tokyo, Japan, for a first-time examination of fertility underwent scrotal examination, semen analysis and blood tests. Testicular volume measured by orchidometer, semen parameters measured by the Makler counting chamber and endocrinological profiles were compared between men with testicular microlithiasis and without testicular microlithiasis. The correlation between sperm concentration and the number of calcifications, and sperm motility and the number of calcifications, were investigated. Results: Of 739 men, 60 (8.1%) were diagnosed as having testicular microlithiasis. Among them, testicular volume, semen volume and motility were lower than those in the men without testicular microlithiasis. Luteinizing hormone and follicle-stimulating hormone levels were higher in those with than those without testicular microlithiasis. The sperm concentration correlated negatively with the number of calcifications. There was no significant correlation between sperm motility and the number of calcifications. Conclusion: Herein, we report the prevalence of testicular microlithiasis in healthy newlywed men. Furthermore, our findings suggest that semen parameters in men with severe testicular microlithiasis tend to be worse. [ABSTRACT FROM AUTHOR]

Introduction: Testicular microlithiasis (TML) was shown to be associated with an increased risk of infertility. However, the association of TML with spermatogenesis in patients with unexplained infertility is still unknown. In this study, we therefore investigated the effect of TML on hormones and sperm parameters in a large cohort of infertile men without major factors for impaired fertility and azoospermic men serving for comparison. Methods: Over a period of 10 years, we retrospectively analyzed 2,914 patients who attended our centre with the diagnosis of unexplained infertility and sperm count >1 million/ejaculate, as well as 281 patients with unexplained azoospermia. From the 2,914 patients, we identified 218 patients with TML as revealed by ultrasound imaging. Further, 26 out of 281 azoospermic patients showed TML. Subsequently, we performed a thorough analysis of reproductive parameters and their association with TML. Results: The overall incidence of TML in patients with unexplained infertility and in unexplained azoospermic men was 7.5 and 9.3%, respectively. Patients with unexplained infertility and TML showed significantly smaller testicular volume, elevated FSH level, and lower sperm count and motility. Impaired spermatogenesis was not associated with the amount of microlithiasis, considered after classification into subgroups (<5 vs. ≥5 microliths/testis), and instead was associated with presence or absence of TML. TML in unexplained infertile azoospermic patients was not significantly associated neither with andrological reproductive parameters nor with sperm retrieval rate in microsurgical testicular sperm extraction. Discussion/Conclusion: TML itself, and not the number of microliths, is associated with impaired spermatogenesis in patients with unexplained infertility. The parameter TML alone is not sufficient to predict spermatogenic impairment in azoospermic patients. This study highlights the importance of ultrasound imaging in the clinical evaluation of infertile men, taking into account that TML is a negative co-factor for male fertility. [ABSTRACT FROM AUTHOR]

Abstract Background Calcifying nanoparticles (NPs) have been proven to be associated with a variety of pathological calcification and previously detected in semen samples from patients with testicular microlithiasis (TM). The present study was designed to test the hypothesis if human-derived NPs could invade the seminiferous tubules and induce TM phenotype. Methods The animals were divided into three groups. Normal saline (0.2 mL) was injected into the proximal right ductus deferens in group A as a control group. The experimental groups, B and C received Escherichia coli (106 cfu/mL, 0.2 mL) and human-derived NPs suspension (0.2 mL), respectively. Rats were euthanized in 2 batches at 2 and 4 weeks. Testicular pathology, ultrastructure and inflammatory mediators were assessed. Results Chronic inflammatory changes were observed at 2 weeks in both groups B and C. Moreover, the innermost layer of sperm cells were structurally impaired and a zone of concentrically layered collagen fibers around the human NPs body was formed in the lumen of the seminiferous tubule in group C only, in which TM phenotype of remarkable calcification surrounded by cellular debris within the seminiferous tubules was built at 4 weeks. Conclusions The results obtained from our study suggested a potential pathogenic effect of NPs in the development of calcification within the seminiferous tubules, which should be addressed in the future studies.

Malignant tumors of the testicle comprise about 1–2 % of all neoplasms in males and 5 % of tumors of the urinary system and male genitals. At early stages, malignant tumors of the testicle have no clinical manifestations. Gradually increasing in size, they change the shape and density of the testicle. Men seeking medical consultation on infertility are recommended to undergo ultrasound examination of the scrotum. As a result, in patients with normal tumor marker levels and lack of symptoms small (less than1 cmin diameter) testicular tumors (incidentalomas of the testicle) and testicular microlithiasis are diagnosed. Lately, a number of studies has shown a possible need to expand indications for organ-preserving treatment, in particular, for incidentalomas of the testicle. Here we present a literature review on this subject and our clinical observations.

Background: An association between testicular microlithiasis (TM) and both carcinoma in situ (CIS) of the testis and testicular germ cell tumors (TGCTs) has been reported. Furthermore, TM seems to be significantly more prevalent in men with male-factor infertility, representing itself a risk factor for TGCT. Nevertheless, the evidence of the association of TM with a higher prevalence of testicular cancer in infertile men remains inconclusive. The aim of this study was to systematically evaluate whether, and to what extent, TM is associated to a significantly higher prevalence of testicular cancer in infertile males.Methods: A thorough search of MEDLINE, SCOPUS, CINAHL, WEB OF SCIENCE, and Cochrane Library databases was carried out to identify case-control studies comparing the prevalence of testicular cancer in infertile men with and without TM. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. In the absence of heterogeneity, odds ratios (ORs) with 95% confidence intervals (CIs) for testicular cancer were combined using a fixed effect model. Funnel plots and trim-and-fill analysis were used to assess publication bias.Results: Eight studies met the inclusion criteria and provided information on 180 infertile men with TM and 5,088 infertile men without TM. The pooled OR indicated that the presence of TM is associated with a ~18-fold higher odd for testicular cancer (pooled OR:18.11, 95%CI: 8.09, 40.55; P < 0.0001). No heterogeneity among the studies was observed (Pfor heterogeneity = 0.99, I2 = 0%). At the sensitivity analysis, similar pooled ORs and 95%CIs were generated with the exclusion of each study, indicating the high degree of stability of the results. The funnel plot revealed a possible publication bias and the trim-and-fill test detected two putative missing studies. Nevertheless, even when the pooled estimate was adjusted for publication bias, there was a still significantly higher odd for testicular cancer in the TM group (adjusted pooled OR: 16.42, 95%CI: 7.62, 35.37; P < 0.0001).Conclusions: In infertile men the presence of TM is associated to an ~18-fold higher prevalence of testicular cancer. Longitudinal studies are warranted to elucidate whether this cross-sectional association actually reflects a higher susceptibility of infertile men with TM to develop testicular cancer over time.

Background: An association between testicular microlithiasis (TM) and both carcinoma in situ (CIS) of the testis and testicular germ cell tumors (TGCTs) has been reported. Furthermore, TM seems to be significantly more prevalent in men with male-factor infertility, representing itself a risk factor for TGCT. Nevertheless, the evidence of the association of TM with a higher prevalence of testicular cancer in infertile men remains inconclusive. The aim of this study was to systematically evaluate whether, and to what extent, TM is associated to a significantly higher prevalence of testicular cancer in infertile males. Methods: A thorough search of MEDLINE, SCOPUS, CINAHL, WEB OF SCIENCE, and Cochrane Library databases was carried out to identify case-control studies comparing the prevalence of testicular cancer in infertile men with and without TM. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. In the absence of heterogeneity, odds ratios (ORs) with 95% confidence intervals (CIs) for testicular cancer were combined using a fixed effect model. Funnel plots and trim-and-fill analysis were used to assess publication bias. Results: Eight studies met the inclusion criteria and provided information on 180 infertile men with TM and 5,088 infertile men without TM. The pooled OR indicated that the presence of TM is associated with a ~18-fold higher odd for testicular cancer (pooled OR:18.11, 95%CI: 8.09, 40.55; P < 0.0001). No heterogeneity among the studies was observed (P for heterogeneity = 0.99, I 2 = 0%). At the sensitivity analysis, similar pooled ORs and 95%CIs were generated with the exclusion of each study, indicating the high degree of stability of the results. The funnel plot revealed a possible publication bias and the trim-and-fill test detected two putative missing studies. Nevertheless, even when the pooled estimate was adjusted for publication bias, there was a still significantly higher odd for testicular cancer in the TM group (adjusted pooled OR: 16.42, 95%CI: 7.62, 35.37; P < 0.0001). Conclusions: In infertile men the presence of TM is associated to an ~18-fold higher prevalence of testicular cancer. Longitudinal studies are warranted to elucidate whether this cross-sectional association actually reflects a higher susceptibility of infertile men with TM to develop testicular cancer over time. [ABSTRACT FROM AUTHOR]

Testicular microlithiasis is an asymptomatic condition associated with calcification within the seminiferous tubule, natural history of which is not clearly known.Association with various testicular malignancies warrant regular follow up in patients with microlithiasis. [ABSTRACT FROM AUTHOR]

Purpose Ultrasonography is a useful tool to measure testicular volume. According to the European Society of Urogenital Radiology, the combination of testicular atrophy and testicular microlithiasis (TML) is a risk factor for testicular cancer. Testicular atrophy is defined as a volume of less than 12 ml. The aim of this study was to compare testicular volume in patients with TML to patients with normal testicular tissue. Materials and Methods From 2013 to 2015 we included a total of 91 adult patients with TML, and 91 adult patients with normal testicular tissue as a control group. All patients underwent scrotal B-mode ultrasound investigation including measurement of width, length and height in both testicles. Testicular volume was calculated using the formula π/6×length×height×width. Results The median age for patients with TML was 48 years (range: 19-94 years), and 48 years (range: 20–75 years) in patients with normal tissue. No statistically significant difference was found between total testicular volume (both testes) >30 ml in patients with TML compared to patients without (OR 0.77 (95% CI 0.43-1.38, p=0.37). However, patients with TML tended to have lower testicular volume compared to patients without TML, when investigating testicular volume below 12 ml. Conclusion Overall, no association was found between testicular volume and TML, but there was a trend indicating that severe atrophy is often seen in patients with TML compared to patients without TML. However, a significant difference was only found in testicular volume ≤8 ml.