Adolescent testicular microlithiasis: A case-based, multinational survey of clinical management practices. Issue 2 (April 2018)

• Record Type: Journal Article
• Authors: Brodie, Katie E.; Saltzman, Amanda F.; Cost, Nicholas G.
• Is Part Of: Journal of pediatric urology. Volume 14:Issue 2(2018)
• Page Start: 151.e1
• Page End: 151.e8
• Publication Date: 2018-04
• Subjects: Testicular -- Microlithiasis -- Management -- Survey -- Malignancy -- Risk; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2017.12.007
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Introduction: Testicular microlithiasis (TM) is a condition characterized by calcium deposits within the testis, usually detected incidentally during ultrasonography of the scrotum. TM has been associated with the presence of, and possibly the development of, testicular malignancy. Our aim was to document international clinical management practices for TM and to analyze what factors and perception of risk influence conservative versus active management and follow-up. 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 TM. Eight cases had a single variable changed each time (classic versus limited TM, unilateral versus bilateral, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management, follow-up plan, length and interval of follow-up. Multivariate logistic regression was performed to determine factors associated with decisions on management and follow-up. Results: There were 265 respondents to the survey from 35 countries (Table ). Median time in practice was 13 years. Factors that were significantly associated with more aggressive initial management (more than counseling on self-examination) included: not yet in independent practice, low volume TM cases per year, those practicing pediatric and adult urology, classic appearance of TM and cryptorchidism. Factors that were significantly associated with urologist follow-up and active investigation included: European practitioners, low TM case volume per year, those practicing both pediatric urology and pediatric surgery, classic TM appearance and a case history of cryptorchidism. Interval and length of follow-up was wide-ranging, with most respondents favoring annual follow-up. Conclusion: Management of TM varies and a mix of surgeon and case factors significantly influences management strategies. This baseline understanding of the lack of systematic management suggests the need for the development of consensus guidelines and prospective study. Table Analysis of the relationship between practitioner-specific factors and decisions about management of testicular microlithiasis. Factor Univariate Multivariate OR 95% CI p -value OR 95% CI p -value Analysis of respondents' initial management of TM (i.e. option selected more involved than solely counseling and self-examination) Region North America 0.308 0.155–0.612 0.001 0.224 0.141–0.355 <0.001 South America 2.308 0.712–7.483 0.164 Ref Europe 1.517 0.782–2.946 0.218 Middle East 2.308 0.939–5.669 0.068 Australasia Ref Time in practice, years 0 2.559 1.771–3.699 <0.001 1.926 1.258–2.948 0.003 1–5 0.771 0.557–1.067 0.117 Ref 6–10 1.114 0.819–1.515 0.493 11–15 1.462 1.040–2.056 0.029 1.445 1.03–0.028 0.033 16–20 1.223 0.863–1.732 0.258 Ref >20 Ref Practice type Pediatric urology 0.375 0.294–0.477 <0.001 0.679 0.527–0.876 0.003 Pediatric and adult urology 1.12 0.820–1.529 0.475 Ref Pediatric urology and pediatric surgery Ref Volume TM cases/year ≤5 2.207 1.752–2.779 <0.001 1.852 1.427–2.405 <0.001 >5 Ref Ref Pattern Classic 1.851 1.506–2.276 <0.001 2.016 1.604–2.536 <0.001 Limited Ref Ref Other risk factor (prior cryptorchidism) Yes 2.046 1.664–2.517 <0.001 2.307 1.834–2.902 <0.001 No Ref Ref Analysis of respondents' follow-up plan of TM (where follow-up involved a urologist ± additional diagnostic tests) Region North America 0.727 0.391–1.354 0.315 Ref South America 1.584 0.468–5.357 0.459 Europe 1.929 1.036–3.593 0.038 1.843 1.309–2.596 <0.001 Middle East 1.68 0.678–4.165 0.263 Ref Australasia Ref Time in practice, years 0 0.883 0.613–1.273 0.506 Ref 1–5 0.698 0.531–0.918 0.01 0.721 0.557–0.934 0.013 6–10 0.82 0.621–1.083 0.162 Ref 11–15 1.131 0.814–1.573 0.463 16–20 1.163 0.836–1.618 0.37 >20 Ref Practice type Pediatric urology 0.336 0.258–0.438 <0.001 0.517 0.377–0.709 <0.001 Pediatric and adult urology 0.461 0.327–0.65 <0.001 0.589 0.406–0.855 0.005 Pediatric urology and pediatric surgery Ref Ref Volume TM cases/year ≤5 1.784 1.469–2.166 <0.001 1.39 1.122–1.724 0.003 >5 Ref Ref Pattern Classic 1.909 1.58–2.308 <0.001 1.993 1.627–2.441 <0.001 Limited Ref Ref Other risk factor (prior cryptorchidism) Yes 2.258 1.864–2.735 <0.001 2.479 2.021–3.041 <0.001 No Ref Ref TM, testicular microlithiasis.