Testicular Microlithiasis: Identifying Calcium Spots in the UK

Testicular microlithiasis (TM) is an asymptomatic condition characterised by the formation of small calcium deposits (microliths) within the seminiferous tubules of the testicles. These deposits are tiny, usually measuring between 1mm and 3mm, and are typically discovered incidentally when a patient undergoes a scrotal ultrasound for an unrelated reason, such as investigating a varicocele or minor trauma.

In the United Kingdom, it is estimated that TM is found in approximately 2% to 5% of healthy men. While the appearance of 'white spots' on an ultrasound scan can be alarming, it is important to understand that TM is not a disease in itself, but rather an imaging finding that requires clinical context to interpret correctly.

One of the most defining characteristics of testicular microlithiasis is the absence of symptoms. Because the calcium deposits are deep within the testicular tissue, they cannot be felt during a physical examination and do not cause pain, redness, or heaviness.

If you are experiencing symptoms such as a dull ache, a hard lump, or sudden swelling, these are likely related to other conditions rather than the microlithiasis itself. Common co-occurring issues identified during scans include:

• Epididymal cysts: Fluid-filled sacs near the testicle.
• Hydrocele: A collection of fluid around the testis.
• Varicocele: Swollen veins within the scrotum.

Historically, there was significant debate within the UK medical community regarding the link between testicular microlithiasis and the risk of developing testicular germ cell tumours (testicular cancer). However, modern research and NICE (National Institute for Health and Care Excellence) evidence suggest that for the vast majority of men, the presence of microliths alone does not significantly increase cancer risk.

The consensus today is that follow-up is generally only necessary if the patient has additional risk factors, such as:

• A personal or family history of testicular cancer.
• A history of undescended testes (cryptorchidism).
• Testicular atrophy (shrinking of the testicles).
• Previous orchidopexy (surgery to move a testicle into the scrotum).

If you have none of these risk factors, current British Association of Urological Surgeons (BAUS) guidance often suggests that routine annual ultrasounds are not required, as the benefit of such screening is low compared to the anxiety it may cause.

Regardless of whether you have been diagnosed with testicular microlithiasis, it is vital to be 'testicle aware'. The NHS recommends that men check their testicles about once a month. This helps you get to know what is normal for you, making it easier to spot changes early.

How to perform a self-exam:

• Perform the check after a warm bath or shower when the scrotal skin is relaxed.
• Support your scrotum in the palm of your hand.
• Use your fingers and thumb to feel each testicle individually.
• Look for hard lumps, changes in size, or a difference in texture.
• Remember that it is normal for one testicle to be slightly larger or hang lower than the other.

If you have received an ultrasound report mentioning testicular microlithiasis and are unsure what it means for your health, you can speak to a GP online for a prompt explanation. An online consultation is a discreet and efficient way to discuss your concerns without waiting weeks for an in-person appointment.

A GP can review your scan results, discuss your medical history, and determine if you meet the criteria for a referral to a urologist. They can also provide guidance on how to perform a self-examination correctly and discuss other aspects of men's health, such as prostate concerns or hormone support. If you require a referral or a sick note due to health-related anxiety or diagnostic procedures, an online doctor can facilitate this based on clinical need.

Diagnosis is made exclusively via ultrasound. Radiologists typically classify TM based on the number of 'specks' seen. 'Classic' testicular microlithiasis is usually defined as having five or more microliths per imaging field. If fewer than five are seen, it is often referred to as 'limited' TM. In the UK, the specific classification rarely changes the management plan unless other abnormalities, like a mass or irregular blood flow, are noted on the Doppler scan.