Is testicular microlithiasis associated with testicular pathologies in children?

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Sefa Sag, Levent Elemen, Kaan Masrabaci, Esma Karadeniz Gungormez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1650782/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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 =0.000, p =0.03, respectively). TM was not detected in patients with epididymo-orchitis, varicocele. Conclusion: We found no association between TM and testicular pathologies. Orchiopexy is likely to increase the prevalence of TM. Testicular pain may be a symptom of microlithiasis. Children Testicular microlithiasis Ultrasonography Introduction Testicular microlithiasis (TM) is a clinical condition characterized by diffuse calcification within seminiferous tubules [ 1 , 2 ]. Several studies have reported that undescended testis is associated with a higher prevalence of TM [ 1 , 3 , 4 ]. In contrast, an adult study found that testicular pathologies were not associated with TM [ 5 ]. Pediatric studies investigating TM are limited [ 2 , 6 , 7 ]. Clinical significance of TM and its relationship with testicular pathologies in children is still a matter of debate [ 1 , 8 , 9 ]. Besides, the question is " Is incidence of TM higher in these patient groups, or is it because they undergo more frequent imaging studies? In the present study, we aimed to analyze the association of testicular pathologies with TM. Patients And Methods The retrospective study included pediatric patients who underwent scrotal ultrasonography (US) due to complaints including testicular pain, discomfort, swelling, scrotal redness in our pediatric surgery outpatient clinic between June 2020 and January 2022. All patients were examined by senior pediatric surgeon and then were referred to US examination. The patients were divided into two groups. Group 1; patients were diagnosed with testicular pathology or presented with testicular pain. Patients were also classified as having undescended testis, epididymo-orchitis, varicocele and testicular pain without testicular pathology in group 1. Group 2 consisted of patients who presented with scrotal edema, inguinal hernia and scrotal redness without testicular pathology. Lastly, group 1 and subgroups of group 1 were compared with group 2. Patients with testicular torsion, hydrocele, scrotal trauma, chromosomal abnormalities, a history of testicular tumor or malignancy and underwent testicular biopsy were excluded from the study. All patients underwent US using high-frequency (12–17 MHz) linear transducers, and multiple longitudinal and transverse gray-scale images of the testes were evaluated. TM was classified as classic (five or more microliths per field of view) or limited (fewer than five microliths per field of view) [ 10 ]. An approval was obtained from the local review board (No: 2022/014). Statistical Analysis Data were analyzed using SPSS for Windows version 18.0 (Chicago, IL, USA). Descriptive statistics were expressed as frequencies (n) and percentages (%) for categorical variables and as mean ± standard deviation (SD) and median (minimum-maximum) for continuous variables. Categorical variables were compared using Chi-square test or Fishers exact test. A p value of < 0.05 was considered significant. 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 were 373 patients in group 1 and 143 patients in group 2. TM was detected in 17 patients in group 1 and six patients in group 2. TM rates were 4.4% in all patients, 4.5% in group 1 and 4.2% in group 2. There was no significant difference between groups 1and 2 with regard to the presence of TM ( p = 0.85). Of the 250 (48.4%) boys diagnosed with undescended testes, seven of them were detected with TM. No significant difference was found compared with group 2 ( p = 0.55). Ten patients had undergone orchiopexy (standard orchiopexy) prior to US examination, and three of them had TM. TM was only present in the operated testis. TM was significantly higher in patients who had undergone orchiopexy compared to group 2 ( p = 0.000). Fifty-eight patients (11.2%) presented with scrotal pain and were found to have no testicular pathology. Among these, seven patients had TM and, TM was significantly higher within this group of 58 patients compared to group 2 ( p = 0.03). Thirty-three patients with epididymo-orchitis and 22 varicocele were included in the study. TM was not detected in patients with epididymo-orchitis, varicocele. Diagnosis-complaint and testicular microlithiasis status of patients were shown in Table 1 . Table 1 Diagnosis-complaint and testicular microlithiasis status of patients Patients with TM n = 23, (%) TM status, n, (%) Unilateral Bilateral 15 (65.2) 8 (34.8) TM type, n, (%) Classic Limited 11 (47.8) 12 (52.1) Diagnosis-complaint n, (%) Undescendes testis Pain without testicular pathology Orchiopexied testis Scrotal edema Inguinal hernia Scrotal redness 7 (30.4) 7 (30.4) 3 (13) 3 (13) 2 (8.6) 1 (4.3) Discussion Prevalence of TM in the pediatric and adult male population ranges from 1.1–5.6% [ 11 ]. Goede et al. found that the prevalence of TM in asymptomatic boys was a rate of 4.2% [ 12 ]. In the present study, the rate of TM in patients with testicular pathology was 4.5%, and it was close to Goede's rates. Previous studies reported that undescended testis is associated with a higher prevalence of TM [ 1 , 3 , 4 ]. In contrast, Pedersen and Chiang et al. revealed that the prevalence of TM in the asymptomatic population is similar to patients with undescended testis [ 5 , 11 ]. In our study, the TM rate in patients with undescended testis was not statistically different from group 2. A study reported an increased incidence of TM in orchiopexy testes [ 13 ]. Similarly, we also found a higher prevalence of TM in patients with a history of orchiopexy. In our patients, TM was present in the operated testis and not in the contralateral testis, which could be explained by the fact that orchiopexy may lead to vascular damage of the testis [ 1 , 4 , 14 ]. Although our cases are limited, our findings support this view. Pain is a leading cause of hospital admission in men and children with TM [ 2 , 5 ]. However, in many studies, no testicular pathology was found in patients presented with pain and were detected with TM on US [ 1 , 2 , 5 ]. In our study, seven (30.4%) patients with TM were admitted with the complaints of pain and were detected with no testicular pathology. Accordingly, the question to be asked is “Is TM itself a cause of pain?”. Further studies are needed on this subject. Literature indicates that most pediatric studies on TM have been conducted by departments other than urology and pediatric surgery [ 1 , 2 , 6 , 7 ]. In these studies, testicular pathologies were evaluated only based on US findings. In our study, however, patients who were examined in the pediatric surgery clinic and whose diagnosis was confirmed by US findings were included in the study. Accordingly, we consider that our study is different from other studies. Our findings contradict with the studies suggesting an increased prevalence of TM in testicular pathologies. The high rate in previous studies may be explained by the more frequent use of imaging studies in these patients. Further studies and larger series are needed on this subject. Our study was limited since it was a retrospective study and the clinical data of patients were retrieved from the hospital database. Another limitation was that all the US examinations were not performed by the same radiologist. In conclusion, we found no association between TM and testicular pathologies. Orchiopexy is likely to increase the prevalence of TM. Testicular pain may be a symptom of microlithiasis. Further studies are needed to elucidate the relationship between testicular pain and TM. Declarations Author contributions Conceptualization: Sefa Sag; Methodology: Sefa Sag, Levent Elemen; Formal analysis and investigation: Sefa Sag; Writing - original draft preparation: Sefa Sag; Writing - review and editing: Sefa Sag, Kaan Masrabaci, Esma Karadeniz Gungormez; Supervision:Sefa Sag, Levent Elemen. All authors read and approved the final manuscript. Conflict of Interest : The authors have no conflicts of interest to declare that are relevant to the content of this article. Funding: No funds, grants, or other support was received. References Yesil S, Tanyildiz HG, Sahin G (2016) How should we monitor boys with testicular microlithiasis? Pediatr Hematol Oncol 33:171–7. doi: 10.3109/08880018.2016.1156203 . Cooper ML, Kaefer M, Fan R, et al (2014) Testicular microlithiasis in children and associated testicular cancer. Radiology 270:857–63. doi: 10.1148/radiol.13130394 . Van der Plas E, Meij-de Vries A, Goede J, et al (2013) Testicular microlithiasis in acquired undescended testis after orchidopexy at diagnosis. Andrology 2013;1:957 – 61. doi: 10.1111/j.2047-2927.2013.00115.x . Van der Plas E, Zijp G, Froeling F, et al (2013) Orchidopexy in late childhood often associated with previously normal testicular position. Eur J Pediatr Surg 23:276–82. doi: 10.1055/s-0032-1333122 . Pedersen MR, Møller H, Rafaelsen SR, et al (2019) Association between risk factors and testicular microlithiasis. Acta Radiol Open 8:2058460119870297. doi: 10.1177/2058460119870297 . Leenen AS, Riebel TW (2002) Testicular microlithiasis in children: sonographic features and clinical implications. Pediatr Radiol 32:575–9. doi: 10.1007/s00247-002-0724-5 . Miller FN, Rosairo S, Clarke JL, et al (2007) Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3,477 patients. Eur Radiol 17:363–9. doi: 10.1007/s00330-006-0296-0 . Dagash H, Mackinnon EA (2007) Testicular microlithiasis: what does it mean clinically? BJU Int 99:157 – 60. doi: 10.1111/j.1464-410X.2006.06546.x . Nakamura M, Moriya K, Nishimura Y, et al (2018) Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study. BMC Pediatr 18:179. doi: 10.1186/s12887-018-1151-6 . Lam DL, Gerscovich EO, Kuo MC, et al Testicular microlithiasis: our experience of 10 years. J Ultrasound Med. 2007;26:867–73. doi: 10.7863/jum.2007.26.7.867 . Chiang LW, Yap TL, Asiri MM, et al (2012) Implications of incidental finding of testicular microlithiasis in paediatric patients. J Pediatr Urol 8:162–5. doi: 10.1016/j.jpurol.2011.03.013 . Goede J, Hack WW, van der Voort-Doedens LM, et al (2009) Prevalence of testicular microlithiasis in asymptomatic males 0 to 19 years old. J Urol 182:1516–20. doi: 10.1016/j.juro.2009.06.065 . Husmann DA (2005) Cryptorchidism and its relationship to testicular neoplasia and microlithiasis. Urology 66:424–6. doi: 10.1016/j.urology.2004.10.020 . Goede J, Hack WW, van der Voort-Doedens LM, et al (2010) Testicular microlithiasis in boys and young men with congenital or acquired undescended (ascending) testis. J Urol 183(4):1539–43. doi: 10.1016/j.juro.2009.12.045 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 12 Jun, 2022 Reviews received at journal 29 May, 2022 Reviewers agreed at journal 17 May, 2022 Reviewers invited by journal 17 May, 2022 Editor assigned by journal 14 May, 2022 Submission checks completed at journal 14 May, 2022 First submitted to journal 12 May, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1650782","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":105932827,"identity":"14a76ee2-3d35-46f7-8a29-106928b5feca","order_by":0,"name":"Sefa Sag","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYDCCA0BcwfCPhx/ESSggVssZhgMykg0gLQYkaLExADEYiNHCd/v4wwcHau7wGJ9fnfjhgQGDPL/YAfxaJM/lGBscOPaMx+zG280SQIcZzpydgF+LwRkeNukPbMxALWc3gLQkGNwmqIX9+Y8D/5h5jGec3fyDSC0MZgwH2w7zGPD3biPOFskzPMYSB/vSeCRu8G6zSDCQIOwXvjPsDz8c+GZjz99/dvPNHxU28vzSBLQggARYpQSxykGA/wApqkfBKBgFo2AkAQA2WUnkD6/CkAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health Sciences, Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sefa","middleName":"","lastName":"Sag","suffix":""},{"id":105932828,"identity":"49dcd97a-1834-44c2-b7e4-0e46c2b52e0e","order_by":1,"name":"Levent Elemen","email":"","orcid":"","institution":"University of Health Sciences, Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Levent","middleName":"","lastName":"Elemen","suffix":""},{"id":105932829,"identity":"958fad32-4a58-43c5-a80c-28e0b871fd57","order_by":2,"name":"Kaan Masrabaci","email":"","orcid":"","institution":"University of Health Sciences, Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kaan","middleName":"","lastName":"Masrabaci","suffix":""},{"id":105932830,"identity":"de2af655-490c-48b7-8206-7ac284d61f58","order_by":3,"name":"Esma Karadeniz Gungormez","email":"","orcid":"","institution":"University of Health Sciences, Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Esma","middleName":"Karadeniz","lastName":"Gungormez","suffix":""}],"badges":[],"createdAt":"2022-05-12 19:29:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1650782/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1650782/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":21579237,"identity":"9917bd09-a596-468b-8db3-e31c32837300","added_by":"auto","created_at":"2022-05-17 18:43:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":180608,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1650782/v1/e996d7c6-493f-45ad-bd50-473a1000e956.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Is testicular microlithiasis associated with testicular pathologies in children?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTesticular microlithiasis (TM) is a clinical condition characterized by diffuse calcification within seminiferous tubules [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Several studies have reported that undescended testis is associated with a higher prevalence of TM [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In contrast, an adult study found that testicular pathologies were not associated with TM [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePediatric studies investigating TM are limited [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Clinical significance of TM and its relationship with testicular pathologies in children is still a matter of debate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Besides, the question is \" Is incidence of TM higher in these patient groups, or is it because they undergo more frequent imaging studies?\u003c/p\u003e \u003cp\u003eIn the present study, we aimed to analyze the association of testicular pathologies with TM.\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003cp\u003eThe retrospective study included pediatric patients who underwent scrotal ultrasonography (US) due to complaints including testicular pain, discomfort, swelling, scrotal redness in our pediatric surgery outpatient clinic between June 2020 and January 2022. All patients were examined by senior pediatric surgeon and then were referred to US examination. The patients were divided into two groups. Group 1; patients were diagnosed with testicular pathology or presented with testicular pain. Patients were also classified as having undescended testis, epididymo-orchitis, varicocele and testicular pain without testicular pathology in group 1. Group 2 consisted of patients who presented with scrotal edema, inguinal hernia and scrotal redness without testicular pathology. Lastly, group 1 and subgroups of group 1 were compared with group 2.\u003c/p\u003e \u003cp\u003ePatients with testicular torsion, hydrocele, scrotal trauma, chromosomal abnormalities, a history of testicular tumor or malignancy and underwent testicular biopsy were excluded from the study.\u003c/p\u003e \u003cp\u003eAll patients underwent US using high-frequency (12\u0026ndash;17 MHz) linear transducers, and multiple longitudinal and transverse gray-scale images of the testes were evaluated. TM was classified as classic (five or more microliths per field of view) or limited (fewer than five microliths per field of view) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e An approval was obtained from the local review board (No: 2022/014).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS for Windows version 18.0 (Chicago, IL, USA). Descriptive statistics were expressed as frequencies (n) and percentages (%) for categorical variables and as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and median (minimum-maximum) for continuous variables. Categorical variables were compared using Chi-square test or Fishers exact test. A \u003cem\u003ep\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 516 patients were included in the study. Median age at the time of US examination was 24 months (range, 1 month \u0026minus;\u0026thinsp;17 years).\u003c/p\u003e\n\u003cp\u003eThere were 373 patients in group 1 and 143 patients in group 2. TM was detected in 17 patients in group 1 and six patients in group 2. TM rates were 4.4% in all patients, 4.5% in group 1 and 4.2% in group 2. There was no significant difference between groups 1and 2 with regard to the presence of TM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.85).\u003c/p\u003e\n\u003cp\u003eOf the 250 (48.4%) boys diagnosed with undescended testes, seven of them were detected with TM. No significant difference was found compared with group 2 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.55).\u003c/p\u003e\n\u003cp\u003eTen patients had undergone orchiopexy (standard orchiopexy) prior to US examination, and three of them had TM. TM was only present in the operated testis. TM was significantly higher in patients who had undergone orchiopexy compared to group 2 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\n\u003cp\u003eFifty-eight patients (11.2%) presented with scrotal pain and were found to have no testicular pathology. Among these, seven patients had TM and, TM was significantly higher within this group of 58 patients compared to group 2 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\n\u003cp\u003eThirty-three patients with epididymo-orchitis and 22 varicocele were included in the study. TM was not detected in patients with epididymo-orchitis, varicocele.\u003c/p\u003e\n\u003cp\u003eDiagnosis-complaint and testicular microlithiasis status of patients were shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDiagnosis-complaint and testicular microlithiasis status of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatients with TM\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;23, (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTM status, n, (%)\u003c/p\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (65.2)\u003c/p\u003e\n \u003cp\u003e8 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTM type, n, (%)\u003c/p\u003e\n \u003cp\u003eClassic\u003c/p\u003e\n \u003cp\u003eLimited\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (47.8)\u003c/p\u003e\n \u003cp\u003e12 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003eDiagnosis-complaint\u003c/span\u003e n, (%)\u003c/p\u003e\n \u003cp\u003eUndescendes testis\u003c/p\u003e\n \u003cp\u003ePain without testicular pathology\u003c/p\u003e\n \u003cp\u003eOrchiopexied testis\u003c/p\u003e\n \u003cp\u003eScrotal edema\u003c/p\u003e\n \u003cp\u003eInguinal hernia\u003c/p\u003e\n \u003cp\u003eScrotal redness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (30.4)\u003c/p\u003e\n \u003cp\u003e7 (30.4)\u003c/p\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003cp\u003e2 (8.6)\u003c/p\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevalence of TM in the pediatric and adult male population ranges from 1.1\u0026ndash;5.6% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Goede et al. found that the prevalence of TM in asymptomatic boys was a rate of 4.2% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the present study, the rate of TM in patients with testicular pathology was 4.5%, and it was close to Goede's rates.\u003c/p\u003e \u003cp\u003ePrevious studies reported that undescended testis is associated with a higher prevalence of TM [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In contrast, Pedersen and Chiang et al. revealed that the prevalence of TM in the asymptomatic population is similar to patients with undescended testis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study, the TM rate in patients with undescended testis was not statistically different from group 2. A study reported an increased incidence of TM in orchiopexy testes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, we also found a higher prevalence of TM in patients with a history of orchiopexy. In our patients, TM was present in the operated testis and not in the contralateral testis, which could be explained by the fact that orchiopexy may lead to vascular damage of the testis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Although our cases are limited, our findings support this view.\u003c/p\u003e \u003cp\u003ePain is a leading cause of hospital admission in men and children with TM [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, in many studies, no testicular pathology was found in patients presented with pain and were detected with TM on US [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In our study, seven (30.4%) patients with TM were admitted with the complaints of pain and were detected with no testicular pathology. Accordingly, the question to be asked is \u0026ldquo;Is TM itself a cause of pain?\u0026rdquo;. Further studies are needed on this subject.\u003c/p\u003e \u003cp\u003eLiterature indicates that most pediatric studies on TM have been conducted by departments other than urology and pediatric surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In these studies, testicular pathologies were evaluated only based on US findings. In our study, however, patients who were examined in the pediatric surgery clinic and whose diagnosis was confirmed by US findings were included in the study. Accordingly, we consider that our study is different from other studies.\u003c/p\u003e \u003cp\u003eOur findings contradict with the studies suggesting an increased prevalence of TM in testicular pathologies. The high rate in previous studies may be explained by the more frequent use of imaging studies in these patients. Further studies and larger series are needed on this subject.\u003c/p\u003e \u003cp\u003eOur study was limited since it was a retrospective study and the clinical data of patients were retrieved from the hospital database. Another limitation was that all the US examinations were not performed by the same radiologist. In conclusion, we found no association between TM and testicular pathologies. Orchiopexy is likely to increase the prevalence of TM. Testicular pain may be a symptom of microlithiasis. Further studies are needed to elucidate the relationship between testicular pain and TM.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Sefa Sag; Methodology: Sefa Sag, Levent Elemen; Formal analysis and investigation: Sefa Sag; Writing - original draft preparation: Sefa Sag; Writing - review and editing: Sefa Sag, Kaan Masrabaci, Esma Karadeniz Gungormez; Supervision:Sefa Sag, Levent Elemen. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: The authors have no conflicts of interest to declare that are relevant to the content of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funds, grants, or other support was received.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eYesil S, Tanyildiz HG, Sahin G (2016) How should we monitor boys with testicular microlithiasis? Pediatr Hematol Oncol 33:171\u0026ndash;7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/08880018.2016.1156203\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCooper ML, Kaefer M, Fan R, et al (2014) Testicular microlithiasis in children and associated testicular cancer. Radiology 270:857\u0026ndash;63. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1148/radiol.13130394\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVan der Plas E, Meij-de Vries A, Goede J, et al (2013) Testicular microlithiasis in acquired undescended testis after orchidopexy at diagnosis. Andrology 2013;1:957 \u0026ndash; 61. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.2047-2927.2013.00115.x\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVan der Plas E, Zijp G, Froeling F, et al (2013) Orchidopexy in late childhood often associated with previously normal testicular position. Eur J Pediatr Surg 23:276\u0026ndash;82. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0032-1333122\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePedersen MR, M\u0026oslash;ller H, Rafaelsen SR, et al (2019) Association between risk factors and testicular microlithiasis. Acta Radiol Open 8:2058460119870297. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2058460119870297\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLeenen AS, Riebel TW (2002) Testicular microlithiasis in children: sonographic features and clinical implications. Pediatr Radiol 32:575\u0026ndash;9. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00247-002-0724-5\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMiller FN, Rosairo S, Clarke JL, et al (2007) Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3,477 patients. Eur Radiol 17:363\u0026ndash;9. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00330-006-0296-0\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDagash H, Mackinnon EA (2007) Testicular microlithiasis: what does it mean clinically? BJU Int 99:157 \u0026ndash; 60. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1464-410X.2006.06546.x\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNakamura M, Moriya K, Nishimura Y, et al (2018) Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study. BMC Pediatr 18:179. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12887-018-1151-6\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLam DL, Gerscovich EO, Kuo MC, et al Testicular microlithiasis: our experience of 10 years. J Ultrasound Med. 2007;26:867\u0026ndash;73. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7863/jum.2007.26.7.867\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChiang LW, Yap TL, Asiri MM, et al (2012) Implications of incidental finding of testicular microlithiasis in paediatric patients. J Pediatr Urol 8:162\u0026ndash;5. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpurol.2011.03.013\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGoede J, Hack WW, van der Voort-Doedens LM, et al (2009) Prevalence of testicular microlithiasis in asymptomatic males 0 to 19 years old. J Urol 182:1516\u0026ndash;20. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.juro.2009.06.065\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHusmann DA (2005) Cryptorchidism and its relationship to testicular neoplasia and microlithiasis. Urology 66:424\u0026ndash;6. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.urology.2004.10.020\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGoede J, Hack WW, van der Voort-Doedens LM, et al (2010) Testicular microlithiasis in boys and young men with congenital or acquired undescended (ascending) testis. J Urol 183(4):1539\u0026ndash;43. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.juro.2009.12.045\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Children, Testicular microlithiasis, Ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-1650782/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1650782/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo analyze the association of testicular pathologies with TM.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThe 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.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA 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 (\u003cem\u003ep\u003c/em\u003e=0.85,\u003cem\u003e p\u003c/em\u003e=0.55, respectively). TM was significantly higher in patients who had undergone orchiopexy and presented with testicular pain compared to group 2 (\u003cem\u003ep\u003c/em\u003e=0.000, \u003cem\u003ep\u003c/em\u003e=0.03, respectively). TM was not detected in patients with epididymo-orchitis, varicocele.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e We found no association between TM and testicular pathologies. Orchiopexy is likely to increase the prevalence of TM. Testicular pain may be a symptom of microlithiasis.\u003c/p\u003e","manuscriptTitle":"Is testicular microlithiasis associated with testicular pathologies in children?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-05-17 18:43:35","doi":"10.21203/rs.3.rs-1650782/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-06-12T19:02:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-05-29T12:18:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"403fb717-6e5e-4d47-8a62-6d84555b0aa7","date":"2022-05-17T17:45:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-05-17T17:05:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-05-14T06:33:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-05-14T04:25:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2022-05-12T19:17:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c82ca22b-8639-448a-bf2c-5e33a622d5fe","owner":[],"postedDate":"May 17th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-07-06T08:29:11+00:00","versionOfRecord":[],"versionCreatedAt":"2022-05-17 18:43:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1650782","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1650782","identity":"rs-1650782","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}