Varicocele is a disease characterized by abnormally engorged veins of the pampiniform plexus. The prevalence of varicocele is approximately 15% in adult males. Multiple classification systems are available for grading varicoceles, all of them are non-ideal. Ultrasound elastography (USE) is a new imaging technology that examines tissue stiffness. Elasticity imaging by USE provides stiffness measurement as additional information to conventional US.
AIM OF THE STUDY:
Is to examine changes in testicular stiffness in varicocele in an attempt to assess the role of Shear wave elastography in testicular varicoceles and to provide additional diagnostic data to further improve and unify a grading system for varicoceles.
PATIENTS AND METHODS:
A cross sectional descriptive study undertaken on sixty-three patients which took place at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, in the period between Jan. 10th to Nov. 11th, 2020. Standard scrotal ultrasonography followed by two-dimensional shear wave elastography were done for all patients. Sixty-three patients (126 testes) were divided to three groups; group (A): testes with a maximum venous diameter of less than 1.9mm representing non-varicose testes, group (B): those with a venous diameter between 2 and 3.4mm, and group (C): with venous diameter of equal or more than 3.5mm. Three stiffness measurements were taken by elastography in supine position with another three measurements in erect posture.
Twenty-seven percent of subjects had normal testes, while 73% had varicoceles. 50% of varicoceles were bilateral, while 48% were left sided. Only one case (2%) had a right sided varicocele. There were no statistically significant differences between the mean volumes of the aforementioned groups. A weak negative correlation observed between the pampiniform venous plexus diameter and testicular stiffness, the mean testicular stiffness of group A was 2.85 ± 0.47 while groups B and C showed a mean stiffness of 2.80 ± 0.51 and 2.73 ± 0.44 kilo Pascals respectively. The differences were statistically insignificant between these groups. There was a highly significant difference between supine and erect testicular stiffnesses. Normal testes showed 19% increase in their mean stiffness in upright posture, as compared to varicose testes which demonstrated 13% increase.
Shear wave elastography is a modern technology, however; its role in discriminating between grades of varicoceles is limited.