Introduction: To demonstrate the relationship between testicular microlithiasis and testicular tumor development. Patients and Methods: Between January 1996 and March 2004, bilateral testicular microlithiasis was found in 40 of the 5,263 patients who underwent scrotal ultrasonography yielding a prevalence of 0.76%. Of the 40 patients, 4 patients with concomitant testicular tumors were excluded from the study. The remaining 36 patients were enrolled into the study and followed by ultrasonography at 6-month intervals. Results: Patient ages ranged between 1 and 69 years ( mean 31 8 14 years). The median ultrasonography follow-up was 34 months ( range, 1 - 96). Testicular tumor development was not observed in any of these 36 patients during the follow-up period. Conclusions: Extensive evaluation including computerized tomography, testicular tumor markers and testicular biopsy of patients with testicular microlithiasis is unnecessary and also increases patient anxiety. Yet annual ultrasonography and physical examination should be performed if ever until testicular microlithiasis is completely accepted as a nonpremalignant disease. Copyright (C) 2005 S. Karger AG, Basel.