Testicular stiffness in varicocele: evaluation with shear wave elastography

Abstract

Purpose: This study was conducted to evaluate the potential role of shear wave elastography (SWE) in the evaluation of testes in patients with varicocele. Methods: A total of 116 testes of 58 patients with left-sided varicocele and 58 testes of 29 agematched healthy controls were included in the study. The patients' testes were classified into groups A (normospermic) and B (oligospermic) based on the presence of oligospermia. The mean SWE values and volume of the testes with varicocele were compared with the contralateral normal testes of the patients and the testes of healthy controls. Results: The mean SWE value of the left testes in groups A (4.77±1.16 kPa) and B (6.15±1.96 kPa) exceeded that of the healthy controls (3.79±0.94 kPa) (P<0.001). The mean SWE value of the left testes in group B (6.15±1.96 kPa) exceeded that of group A (4.77±1.16 kPa) (P=0.002). No correlation was observed between testicular stiffness and the grade of varicocele (r=0.102, P=0.423). Conclusion: The testes with varicocele were stiffer than the contralateral testes and the testes of healthy controls, and SWE might play an auxiliary role to conventional ultrasonography in assessing pathologic alterations in the testis owing to varicocele.

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 …”

“…The testicular stiffness measure with SWE of the VC-bearing testicles in infertile men with unilateral clinical or subclinical VC and oligo-astheno-teratozoospermia (OAT) was found to be significantly lower in comparison to fertile men and normal testes [ 14 ]. Turna and Aybar [ 15 ] found that VC testicles were stiffer in comparison to the contralateral normal ones in patients who were normospermic or oligospermic, whereas testicles with VC were stiffer in comparison to testicles of normal controls regardless of dyspermia; on the other hand, there was no difference in stiffness between the right and left testicles of normal controls. 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 ].…”

“…The authors mentioned that ‘testicular volume is not a reliable parameter for reflecting the degree of parenchymal damage’, but there was no correlation with histopathological findings where the participants were not mentioned to be infertile. Finally, in a study including oligospermic and normospermic men with VC, testicular volume was also lower on the side with VC in comparison to the contralateral normal ones (irrespective of oligospermia or not), but no significant correlation was observed between SWE stiffness and the volume of the testes [ 15 ].…”

“…On the other hand, a study found no correlation between the sonographic grade (classified according to the Sarteschi system) and SWE readings in 36 infertile patients with Grade I–III VC [ 21 ]. Using the same modality, no correlation was found between clinical grade and SWE readings in a study of 58 men with VC (normospermic and oligospermic) [ 15 ]. Finally, in a similar population of patients, a study stated no correlation between grade and strain elastography readings.…”