Shear wave elastography in varicocele patients: Prospective study to investigate correlation with semen parameters and histological findings

Abstract

Shear wave elastosonography (SWE) is a non-invasive ultrasound (US) imaging modality used to assess the mechanical properties of tissues such as rigidity and elasticity. 1 This technique allows the evaluation of the degree of fibrosis caused by parenchymal alterations in several organs such as liver, kidney, muscle, thyroid and breast. 2-8 As a semi-quantitative elastographic technique, SWE compares the elasticity and stiffness of target tissues with nearby normal ones. 9 As described by Aigner et al, the use of SWE for the evaluation of testicular tissues is a new concept with high sensitivity rate

The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review

“…Of the 539, 349 (mean [SD] age 36.7 [7.6] years) had OAT; 132 men had left VC To evaluate the reproducibility and practicality of using testicular SWE To evaluate tissue stiffness in normal and infertile patients and to assess the correlation between testicular volume and stiffness Yavuz et al [ 21 ] SWE – ARFI Prospective study 100 patients, 36 with VC Age 19–49 years, mean [SD] 28.77 [6.11] years To assess the reliability of testicular stiffness quantification using SWE in evaluating male fertility potential and for pre-diagnosis of diseases through sperm quantification Bitkin et al [ 19 ] Strain elastography Prospective study 30 infertile patients with VC (mean [SD] age 25.61 [6.06] years). 30 normal controls (mean [SD] age 27.94 [4.22] years) To use strain elastography to evaluate structural testicular changes that occur secondary to VC To assess the relationship between strain elastography and patients’ hormone levels and semen analysis Salama et al [ 18 ] Strain elastography Prospective study 50 infertile men with left VC (mean [SD] age 29.3 [4.4] years) and 20 age-matched controls (mean [SD] age 29.5 [4.6] years) To use real-time strain elastography to assess testes in patients with VC and to correlate these results with their clinical, hormonal and seminal profiles Erdogan et al [ 16 ] SWE Prospective study 48 patients (mean [SD] age 28.56 [8.95] years) with VC and 52 controls (mean [SD] age 28.79 [11.62] years) were divided into 3 groups (A: testicles with VC, B: contralateral normal testicles, C: normal group) To use SWE, with measurement of elasticity and volume, to determine histological damage in patients with VC Fuschi et al [ 17 ] SWE Prospective study 82 male patients (mean [SD] age 27.44 [6.095] years) with clinical, left VC and a progressive alteration of semen quality were enrolled Patients were evaluated before varicocelectomy, and at 3 and 6 months postoperatively To use SWE to evaluate the impact of varicocelectomy on degree of fibrosis, and testes elasticity and function To evaluate the relationship between SWE and patients’ histology and semen parameters Turna and Aybar [ 15 ] SWE Prospective study 58 patients (mean [SD] age 3...…”

“…30 normal controls (mean [SD] age 27.94 [4.22] years) To use strain elastography to evaluate structural testicular changes that occur secondary to VC To assess the relationship between strain elastography and patients’ hormone levels and semen analysis Salama et al [ 18 ] Strain elastography Prospective study 50 infertile men with left VC (mean [SD] age 29.3 [4.4] years) and 20 age-matched controls (mean [SD] age 29.5 [4.6] years) To use real-time strain elastography to assess testes in patients with VC and to correlate these results with their clinical, hormonal and seminal profiles Erdogan et al [ 16 ] SWE Prospective study 48 patients (mean [SD] age 28.56 [8.95] years) with VC and 52 controls (mean [SD] age 28.79 [11.62] years) were divided into 3 groups (A: testicles with VC, B: contralateral normal testicles, C: normal group) To use SWE, with measurement of elasticity and volume, to determine histological damage in patients with VC Fuschi et al [ 17 ] SWE Prospective study 82 male patients (mean [SD] age 27.44 [6.095] years) with clinical, left VC and a progressive alteration of semen quality were enrolled Patients were evaluated before varicocelectomy, and at 3 and 6 months postoperatively To use SWE to evaluate the impact of varicocelectomy on degree of fibrosis, and testes elasticity and function To evaluate the relationship between SWE and patients’ histology and semen parameters Turna and Aybar [ 15 ] SWE Prospective study 58 patients (mean [SD] age 32.81 [9.07] years) with left-sided VC and 58 normal controls (mean [SD] age 34.23 [9.09] years) VC group: Patients’ testes were classified into Group A (normospermic) or Group B (oligospermic) Mean SWE values and testicular volume were recorded To assess the role of SWE to evaluate testes in patients with VC To evaluate the correlation between testicular stiffness and VC …”

“…Higher SWE values in VC-bearing testicles in comparison to the contralateral normal ones were also seen in a recent study but the fertility status of the participants was not documented [ 16 ]. Finally, a recent prospective study of men with Grade III VC and worsening semen parameters reported significantly higher SWE values in the left testicles carrying VC in comparison to the right side [ 17 ].…”

“…Moreover, a significant positive correlation between the difference of pre- and postoperative left SWE and testicular volume was found. Also, a significant negative correlation between postoperative SWE of left testis and ipsilateral testicular volume and sperm count at 3 months was observed [ 17 ].…”

“…Thus, elastography might not be as decisive and the clinical context will guide the management. However, Fuschi et al [ 17 ] reported that the histopathological reversal of testicular architecture follows the shift in SWE readings, which implies that elastography could document the recovery of spermatogenesis and the success of treatment. Moreover, this might give new insights in unexplored fields, such as bilateral subclinical VCs, where there is no clinical tool apart from a testicular biopsy to assist in the prognosis of men undergoing surgery [ 39 ].…”