Evaluation of postoperative undescended testicles using point shear wave elastography in children

Evaluation of testicular stiffness in boys with unilateral cryptorchidism after orchiopexy by ultrasound strain elastography

PURPOSE

We assessed the stiffness of unilateral undescended testes after orchiopexy, examining its value in tracking histopathological changes and fertility potential during postoperative follow-up. Additionally, we explored the optimal timing for surgery based on testicular stiffness.

PATIENTS AND METHODS

Thirty-six boys who had been diagnosed with unilateral undescended testis and treated with orchiopexy were included in the study. Testicular stiffness was evaluated several times over respective follow-up periods by ultrasound strain elastography after orchiopexy. The strain ratios were measured as the ratios of the elasticities of the descended testis to those of the operated testes. The patients were divided into two groups based on the age at which they underwent orchiopexy:under < 2 years (Group A) and ≥ 2 years (Group B).

RESULTS

The mean strain ratios were 0.90 ± 0.32 and 0.92 ± 0.20 in Groups A and B, respectively. In Group A, the strain ratio was constant regardless of postoperative months (r = 0.01, p = 0.99); however, in Group B, it tended to increase with postoperative months (r = 0.42, p = 0.07).

CONCLUSIONS

Evaluation of testicular stiffness may be useful for the estimation of histopathological changes and fertility potential in boys with unilateral undescended testes at follow-up appointments after orchiopexy. Our data indicate that performing orchiopexy as early as possible may be recommended to avoid testicular damage.

Diagnostic role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study

Aim

Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes.

Material and methods

Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group.

Results

Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group's echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes.

Conclusion

The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.

Radiological Evidence of Testicular Damage in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Sonoelastography's Potential Role

ABSTRACT

This preliminary study aimed to evaluate the possible damage to the male reproductive system that the severe acute respiratory syndrome coronavirus 2 virus causes by quantitatively measuring and comparing the tissue stiffness of the testis and epididymis with acoustic radiation force impulse sonoelastography in patients who have COVID-19 with a healthy control group. This prospective study was conducted between February and July 2021 with 65 cases. We used sonoelastography to evaluate male patients 18 years or older, who had applied to the urology clinic with nontesticular complaints, and were found to not have any underlying testicular pathology after a clinical-laboratory evaluation. The clinical-laboratory imaging findings and reverse transcription-polymerase chain reaction test results of all patients diagnosed with COVID-19 were reviewed from the hospital database. We measured the shear wave velocity values of the epididymis and the testes of 31 proven severe acute respiratory syndrome coronavirus 2 patients and 34 healthy subjects and compared them with an independent t test. For the patient and control group subjects, the mean age was 37.55 ± 13.08 (23-71) and 40.5 ± 16.25 (18-81) years, respectively. The mean shear wave velocity values of the left-right and bilateral testes and epididymis of the patient group were statistically substantially higher ( P ˂ 0.05) than in the control group. In the receiver operating characteristic analysis, when the cutoff values for the bilateral testes and epididymis were determined as 1.39 and 1.64 m/s, respectively, the AUC was 77% to 73.4%, the sensitivity was 87% to 74%, and the specificity was 65% to 62%. Our findings show that testicular and epididymal tissue stiffness increased in patients with COVID-19. We recommend adding sonoelastography to urogenital examinations of male reproductive system in patients who are recovering from COVID-19.

Testicular Evaluation Using Shear Wave Elastography (SWE) in Patients with Varicocele

PURPOSE

To assess the possible influence of the presence of varicocele on the quantification of testicular stiffness.

METHODS

Ultrasound with shear wave elastography (SWE) was performed on 48 consecutive patients (96 testicles) referred following urology consultation for different reasons. A total of 94 testes were studied and distributed in three groups: testes with varicocele (group A, n = 19), contralateral normal testes (group B; n = 13) and control group (group C, n = 62). Age, testicular volume and testicular parenchymal tissue stiffness values of the three groups were compared using the Kruskal-Wallis test.

RESULTS

The mean age of the patients was 42.1 ± 11.1 years. The main reason for consultation was infertility (64.6%). The mean SWE value was 4 ± 0.4 kPa (kilopascal) in group A, 4 ± 0.5 kPa in group B and 4.2 ± 0.7 kPa in group C or control. The testicular volume was 15.8 ± 3.8 mL in group A, 16 ± 4.3 mL in group B and 16.4 ± 5.9 mL in group C. No statistically significant differences were found between the three groups in terms of age, testicular volume and tissue stiffness values.

CONCLUSION

Tissue stiffness values were higher in our control group (healthy testicles) than in patients with varicocele.

Evaluation of testicles by sonoelastography in men recovering after Covid-19 disease

INTRODUCTION

Testicular cells, seminiferous tubule cells, spermatogonia, Leydig and Sertoli cells showing angiotensin-converting enzyme 2 expression have the potential to be targets and to be damaged by the coronavirus. We aimed to use Two-Dimensional Shear Wave Elastography (2D-SWE) as an effective technique to identify parenchymal damage in the testicles of patients recovering from COVID-19 infection.

METHODS

35 Male patients (group 1) who recovered after COVID-19 infection between 4 and 12 weeks were included in this prospective study. Before 2D-SWE, these male patients were confirmed with control Rt-PCR test negativity. In addition, the first Rt-PCR test positivity of these patients was confirmed. A control group was formed of 31 healthy subjects (group 2). These two groups were compared in terms of age, volume of each testis, and SWE values. Ultrasound including SWE was applied to all the testes. A total of 9 measurements were taken as 3 SWE measurements from each third of the testis (superior, mid, inferior) and the average of these was calculated. Data obtained in the study were analyzed statistically. A value of p < 0.05 was accepted as statistically significant.

RESULTS

The mean SWE values for the right testis and the left testis were determined to be statistically significantly higher in Group 1 than in Group 2, respectively (p < 0.001, p < 0.001).

CONCLUSION

There is an increase in testicular stiffness in males who have recovered from COVID-19 infection. The underlying cause of testicular damage is changes at the cellular level. The 2D-SWE technique can predict potential testicular parenchymal damage in male patients recovering from COVID-19 infection.

IMPLICATIONS FOR PRACTICE

Two-Dimensional Shear Wave Elastography (2D-SWE) seems to be a promising imaging technique in the evaluation of testis parenchyma.

Elastography in the Urological Practice: Urinary and Male Genital Tract, Prostate Excluded—Review

The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.

THE ROLE OF ULTRASOUND ELASTOGRAPHY IN THE DIAGNOSIS OF PATHOLOGIC CONDITIONS OF TESTICLES AND SCROTUM

Several years ago, elastography emerged as a potentially very useful ultrasound technique that is currently used in diagnostic workup of the breast, liver and some other organ systems, whereas for other ones it is still mainly in the phase of research. The aim of the study was to compare elasticity index (EI) of testicles using strain elastography in healthy subjects and those with pathologic changes of testicles/scrotum. A total of 117 patients were included in the study. Measurements were performed on a Logiq E9 ultrasound system using strain elastography. In healthy subjects, the mean EI value was 1.34±0.35 for right testis and 1.49±0.47 for left testis. Increased mean EI values were found in the following six conditions: patients with varicocele, infertile patients, solitary testis after orchidectomy of the other testicle because of tumor, patients with testicular tumors, patients after orchidopexy of undescended testicle, and patients with congenitally smaller testicle. There is a paucity of literature data on the use of elastography in testes, as well as on normal elastography values in testicular tissue. Strain elastography was demonstrated to be a valuable method to acquire additional information in patients with pathologic changes in testicles/scrotum. These data provide reference values for further research in a larger sample of subjects.

Diagnostic Accuracy of Virtual Touch Quantification and Virtual Touch Imaging Quantification Sonoelastography Techniques in Pediatric Undescended Testes Patients

The purpose of this study was to determine the usefulness of virtual touch quantification (VTQ) and virtual touch imaging quantification (VTIQ) techniques for assessing undescended testes stiffness, by age and location. One testicle from each of 84 participants (31 of whom were healthy volunteers) was assessed by the point shear-wave elastography (p-SWE) method, using both VTQ and VTIQ techniques. The patients were grouped by location of assessment (intra-abdominal, inguinal, and scrotal) and age (group 1, healthy patients; group 2, patients age one and younger; and group 3, patients older than age one). Although the VTQ and VTIQ methods for group 2 showed similar results in the Bland-Altman plot, for group 3, the VTIQ method was more effective than the VTQ method. The use of p-SWE with VTIQ may be an appropriate technique for determining the tissue stiffness of testes located in the inguinal canal and for patients over one year of age.

Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations

The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.

Shear wave elastography evaluation of testes with non-communicating hydrocele in infants and toddlers: A preliminary study

INTRODUCTION

Shear wave elastography (SWE) is a new technology and non-invasive ultrasound device that can measure tissue rigidity and elasticity.

OBJECTIVE

This controlled prospective study aimed to demonstrate using SWE whether there was a difference between the elasticity of testes with non-communicating (NC) hydrocele in infants and toddlers and elasticity of controls' testes without hydrocele, and to reveal quantitative values of elasticity reflecting histological findings.

MATERIAL AND METHODS

Testes of 37 cases at an average age of 6.32 months and diagnosed with NC hydrocele between December 2016 and April 2017 were evaluated for hydrocele and testicular volumes, and testes elasticity through ultrasonography and SWE.

RESULTS

Of all cases, 15 had bilateral hydroceles, while 22 were diagnosed with unilateral hydrocele. Testes with NC hydrocele (n = 52) in infants and toddlers were compared with testes without hydrocele (n = 36) in controls. Median hydrocele volume of 52 testes with NC hydrocele was 5.0 cm³ (0.2-37). Median volume of testes with hydrocele was 0.6 cm³ (0.2-1.5) in the study group, and 0.5 cm³ (0.3-1) in controls (P = 0.577). Although median elastography values were measured as 1.67 m/s (1.29-2.59) and 10.0 kPa (2.1-23) in patients, those of controls were found to be 1.61 m/s (1.27-2.34) and 8.25 kPa (5.1-18.9) (P = 0.03, P = 0.005, respectively). While there was no between-group difference in testes volumes, a statistically significant difference was observed in SWE-derived quantitative data (Summary Table).

DISCUSSION

As a novel elastographic method, SWE is used to track shear waves passing through tissues by quantifying the elasticity of structures and nodules, such as liver fibrosis, and to improve the characterization of breast and thyroid nodules. Shear wave elastography was assessed to be a beneficial ultrasonography tool to predict the histologic features of undescended testicles, which might replace testicular biopsy in the modern management of undescended testes. This study also quantitatively measured whether there was a change in testicular tissues with NC hydrocele through SWE, and found that SWE values of testes with NC hydrocele were significantly higher compared with those of controls, despite the absence of a significant difference in testes volumes.

CONCLUSIONS

The present study confirmed that quantitative changes in testes elasticity can reliably be evaluated through SWE. Non-communicating hydrocele may be damaging to testicular tissues. More definitive results will be achieved with further comprehensive studies including larger patient populations. It is believed that the operation age of children with NC hydrocele can be re-evaluated in the future.

Evaluation of Pediatric Undescended Testes with Elastosonography

Background

Undescended testes, which are defined as the failure of testes to descend to scrotum, are the most common developmental defect in male infants. Indirect evaluation of histologic damage can be performed with the help of palpation during operation. Hard texture of testes tissue is likely related with histological damage. Real-time elastography is an emerging technology of ultrasonic imaging of soft tissue strain and elasticity, it aims at providing information regarding the mechanical properties of tissues, such as their hardness or stiffness. This study aim was to investigate the changes in strain and elasticity of testes tissue by using elastography technique.

Materials and methods

A total of 32 patients, who had undescended testes were included in this study. Only two patients had bilateral undescended testes, other patients had unilateral. The age of the patients were recorded according to the time of ultrasonographic (USG) examination. The undescended testes was displayed in the elastographic box with the neighbouring subcutaneous fat tissues. The strain ratios were measured as the ratios of the elasticities of the subcutaneous fat tissue to the elasticities of the undescended testes.

Results

A total of 32 patients with 34 testes were included in the study. The mean age of the patients with undescended testes was 32.6 months (range 7-60 months). The mean strain ratios were 0.67 (range 0.12-1.41) for the undescended testes and there were no significant differences in undescended testes strain ratios related to patient age (p = 0.453).

Conclusion

This preliminary study showed that there were no significant fibrosis which can be demonstrated with elastosonography before the age of 5 years old. Additional studies with his-topathological results are needed to identify sensitivity and specificity of elastosonography in undescended testis and in planning optimal operation time for these patients.