Prognostic values of shear wave elastography in adolescent boys with varicocele.
INTRODUCTION
Shear wave elastography is an ultrasound technique for non-invasive quantification of tissue stiffness. It was used in assessing testis elasticity in some scrotal abnormalities, such as undescended pediatric testes or adult varicocele testes. In this study, its usefulness in adolescent patients with varicocele was examined.


OBJECTIVE
The aim of this study was to quantify elasticity of testes with the use of elastography and comparison of the results with typical threshold values used in varicocele management in adolescent patients with varicoceles.


STUDY DESIGN
In 30 patients with clinically diagnosed left varicoceles, quantitative 2D shear wave imaging of varicocele testes and contralateral ones were performed.


RESULTS
The relationships between the grade of varicocele and elastography were calculated. The stiffness was 2.5 ± 0.49 kPa in testes with grade I of varicocele, 2.59 ± 0.81 in grade II and 2.80 ± 0.72 kPa in grade III. In contralateral testes, it was respectively grade I 2.39 ± 0.49 kPa, grade II 2.41 ± 0.61 kPa, and grade III 2.42 ± 0.85 kPa. The statistical significance was close to importance in grade III (P = 0.153). There was a statistically significant difference between elastography results in patients with volume difference over 20%. In testes with varicocele, it was 2.77 ± 0.75 kPa and in contralateral testes, 2.37 ± 0.65 kPa (P < 0.05). In patients with testis volume difference between 0 and 20%, elastography results were comparable, and it was 2.45 ± 0.57 kPa in testes with varicocele and 2.44 ± 0.61 kPa in contralateral testes (Table).


DISCUSSION
Ultrasound is currently the most widely used imaging technique for the assessment of varicocele, but its role in the diagnostic algorithm is still controversial. Therefore, many attempts are made to determine the manifestations of testicular damage that precede morphological deterioration, which could increase the importance of imaging techniques in treatment planning.


CONCLUSION
The changes of tissue elasticity due to varicocele seem to confirm the need of surgery in patients with testis volume difference more than 20% and in grade III of varicocele (Table). In case of validation of diffuse testis changes, they could indicate the need for surgery also in other stages.