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

Jibril Oyekunle Bello; Kamran Hassan Bhatti; Nazim Gherabi; Joseph Philipraj; Yash Narayan; Georgios Tsampoukas; Nisar Shaikh; Athanasios Papatsoris; Mohamad Moussa; Noor Buchholz

doi:10.1080/2090598X.2021.1964256

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

Arab J Urol. 2021 Sep 16;19(3):255-263. doi: 10.1080/2090598X.2021.1964256. eCollection 2021.

Authors

Jibril Oyekunle Bello^{1

2}, Kamran Hassan Bhatti^{1

3}, Nazim Gherabi^{1

4}, Joseph Philipraj^{1

5}, Yash Narayan^{1

6}, Georgios Tsampoukas^{1

6}, Nisar Shaikh^{1

7}, Athanasios Papatsoris^{1

8}, Mohamad Moussa^{1

9}, Noor Buchholz¹

Affiliations

¹ U-merge Ltd. (Urology for Emerging Countries), London, UK.
² Urology unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
³ Urology section Hamad Medical Corporation Alkhor Qatar.
⁴ Andrology committee of the Algerian Association of Urology, Algiers, Algeria.
⁵ Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.
⁶ Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK.
⁷ Department of Urology, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, Larkana, Pakistan.
⁸ 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁹ Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.

Abstract

Objective: To review the role of elastography in the evaluation and decision-making of adult, infertile men with varicocele.

Methods: A systematic search using the terms (Elastography) AND (Varicocele), (Stiffness) AND (Varicocele), (Elastography) AND (Male infertility) was performed in Pubmed/Medline. Studies reporting a) elastographic characteristics in varicocele-bearing comparing to normal testicles, and b) the correlation of elastography with varicocele grading, parameters of spermatogenesis, and outcomes of varicocele treatment were selected. Exclusion criteria were animal, adolescents, abstracts, and non-English language studies.

Results: In total, 453 articles were identified; 11 eligible studies were selected. Several modalities were used (shear wave elastography, strain elastography, quasistatic ultrasound elastography, acoustic radiation force impulse). Varicocele-bearing testicles have significantly different stiffness and elasticity in comparison to normal and non-varicocele testicles. Although not in full agreement, elastography readings are correlated with semen parameters. Conflicting results were reported regarding grading as most of the studies failed to demonstrate a significant correlation. Shear wave elastography showed a significant correlation with the improvement in semen parameters after varicocelectomy, but the association with pregnancy rates is unknown. Finally, no studies were identified comparing elastography with other modalities.

Conclusions: Elastography can detect changes in the architecture of varicocele-bearing testicles. Although the role of the modality in grading is uncertain, elastography showed a meaningful correlation with spermatogenesis parameters. Importantly, elastography readings could predict the improvement in semen parameters after varicocelectomy which is useful in terms of decision-making in infertile men with varicocele.

Abbreviations: ARFI: acoustic radiation force impulse; CDUS: colour Doppler ultrasonography; DWI: diffusion-weighted imaging; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SWE: shear wave elastography; VC: varicocele.

Keywords: Elastography; male infertility; stiffness; varicocele.