't Hoen Lisette A, Bhatt Nikita R, Radmayr Christian, Dogan Hasan S, Nijman Rien J M, Quaedackers Josine, Rawashdeh Yazan F, Silay Mesrur S, Tekgul Serdar, Stein Raimund, Bogaert Guy
Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Urology, East of England Deanery, Urology, Cambridge, United Kingdom.
J Pediatr Urol. 2021 Dec;17(6):815-831. doi: 10.1016/j.jpurol.2021.06.013. Epub 2021 Jun 13.
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.
睾丸微石症（TM）与良性和恶性疾病的确切关联尚不清楚，尤其是在儿科人群中。TM与成年期睾丸恶性肿瘤的潜在关联引发了关于管理和随访的争议。
确定儿童TM与睾丸恶性肿瘤或不育风险的相关性的预后重要性，并比较儿科和成人人群之间的差异。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明，我们对截至2020年11月的Medline、Embase和Cochrane对照试验数据库进行了文献综述。分析纳入了26篇出版物。
在对595例TM患儿的随访中，只有1例TM患儿在青春期发生了睾丸恶性肿瘤。在其他594例中，即使存在危险因素，也未发现睾丸恶性肿瘤。在成人人群中，与无TM的患者相比，有隐睾病史（6%对0%）、睾丸恶性肿瘤病史（22%对2%）或亚/不育病史（11 - 23%对1.7%）的TM患者发生睾丸恶性肿瘤的风险增加。儿科和成人人群之间的差异可能是由于随访时间短，在6个月至3年之间不等。由于纳入时的平均年龄为10岁，且预计睾丸恶性肿瘤从青春期开始发生，睾丸恶性肿瘤可能尚未发生。
TM是一种常见的偶然发现，在儿童期似乎与睾丸恶性肿瘤无关，但在存在危险因素的情况下，与成人人群的睾丸恶性肿瘤有关。建议从青春期开始对有相关危险因素的儿童进行每月一次的常规睾丸自我检查。当在向成年期过渡时TM仍然存在时，可以考虑更密切的随访。
