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