The implications and follow up of testicular microlithiasis have been widely debated since a possible link with testicular germ cell tumour was reported. In 2015 the European Society of Urogenital Radiology (ESUR) have published the first guidelines on follow up of this condition. As a general rule it does not need follow up, unless there is a seperate risk factor for germ call cancer. Testicular maldescent/orchidopexy, previous germ cell tumour and atrophic testis require annual testicular ultrasound (USS) follow up. Genetic disease requires an USS at 6 and 12 months then discharge. Family history of germ cell tumour requires advice of self examination.