Elastography to assess the effect of varicoceles on testes: a prospective controlled study

Abstract

Varicoceles are the most common and treatable cause of male infertility. The pathophysiology of varicoceles primarily includes elevated temperature, adrenal hormone reflux, gonadotoxic metabolite reflux, altered testicular blood flow, antisperm antibody formation and oxidative stress. The diagnosis of a varicocele is mainly clinical. However, a Doppler ultrasound is used to obtain clinical data and to more accurately measure testicular size. Acoustic radiation force impulse (ARFI) is an additional technique to simultaneously show different areas with different densities in a colour-coded image and a B-mode or greyscale image. This can be used for structural analysis of testicular tissue and has become an additional method for detecting pathologic tissue alterations. We enrolled 30 patients who had clinically diagnosed with left varicoceles and male infertility (Group 1). All patients were evaluated by history taking, physical examination, a spermiogram and an endocrine profile. Thirty control patients (Group 2) were randomly chosen from patients who had applied to an andrology clinic for infertility; their physical examinations and laboratory results showed normal findings. Mean elastography results were significantly different between the groups, and significantly lower in patients who had varicoceles. The relationship between hormonal profiles and elastography parameters was calculated as statistically significant negative correlations between FSH and elasticity. Additionally, a negative correlation was determined between varicocele grade and elasticity of testes. In conclusion, our prospective study showed that ARFI imaging may be more useful than palpation for determining early damage of testicular structure by varicoceles.

Evaluation of the diagnostic efficacy of strain elastography in infertile population with normal and abnormal semen parameters

“…[4,23,24] Tissue elasticity generally correlates with pathological conditions of the testicular parenchyma In most of the cases, a normal testicular biopsy excludes the diagnosis of testicular pathologies. [25] Some focal testicular lesions such as testicular microlithiasis, azoospermia and lesions with a diameter of <10 mm, particularly if they are not palpable, were investigated with the use of sonoelastography technique.…”

“…Dede et al [24] investigated the relationship between elastography scores, serum FSH levels and varicocele. They concluded that testicular elasticity was inversely correlated with serum FSH and varicocele grade.…”

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

“…Acoustic radiation force impulse (ARFI) elastography represents one of the main types of elastography currently in use, involving the estimation of shear wave speed. In a prospective controlled study of 30 men with clinical varicocele and 30 controls, Dede et al[61] concluded that ARFI elastography may be used to assess the early damage of testicular structure by varicocele[61]. Mean elastography results were significantly different between the two groups and significantly lower in testes with varicoceles.…”

“…Significant negative correlations between FSH and testis elasticity was also reported. Additionally, a negative correlation was determined between varicocele grade and elasticity of testes[61]. …”

Lower body mass index and higher height are correlated with increased varicocele risk

“…that testicular elasticity was negatively associated with varicocele grade by ultrasound elastography(Dede et al, 2016). Recently, magnetic resonance imaging (MRI) as a noninvasive imaging technique has been performed to detect early signs of testes dysfunction in men with varicocele.…”