Login to Access Video or Poster Abstract: MP66-14
Sources of Funding: None

Introduction

Testicular microlithiasis (TM) is a condition characterised by calcium deposits within the testis, mostly detected incidentally. TM has been postulated to increase the risk of developing testicular malignancy. Our aim was to document international clinical management practices of post-pubertal adolescent patients with TM, and to analyze what factors and perception of risk influence conservative versus active management and follow-up patterns.

Methods

European Society for Paediatric Urology (ESPU) and Society for Pediatric Urology (SPU) members were invited to complete an online case-based survey of clinical management practices of testicular microlithiasis. Eight cases were presented, each based on a 15-year-old post-pubescent male. These assessed three variables (classic versus limited patterns of TM, unilateral versus bilateral TM, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management and follow-up plan, as well as length and duration of follow-up.

Results

There were 265 respondents to the survey from 35 countries. Median time in practice was 13.0 yrs (range 0-45 yrs). Median number of TM cases encountered per year was 4.5 (range 0-75). Factors significantly correlated on multivariate logistic regression analysis (p<0.05) with more aggressive initial management (more than counselling and teaching testicular self-examinations) included: not yet in independent practice, low volume of TM cases seen per year, those practicing pediatric and adult urology (vs. pediatric urology alone), classic pattern of TM and prior history of cryptorchidism. Factors that significantly correlated (p<0.05) with recommending urology follow-up and active investigation included: European practitioners, low volume of TM cases seen per year, those practicing combined pediatric urology and pediatric surgery, classic pattern of TM and prior history of cryptorchism_x000D_ Interval and length of follow-up were wide-ranging, with annual follow-up favoured by a majority.

Conclusions

The management of TM varies widely among those surveyed and a variety of surgeon and case-specific factors significantly affected selection of management strategies. Guidelines are much needed to recommend management and surveillance of adolescent patients with TM. These data on surgeons' perceptions of TM are important in informing the development of such guidelines.

Funding

None