Validity of measurements of testicular volume obtained by a built-in software of ultrasound systems: with formula recommended by updated guidelines as reference

[Late - onset hypogonadism syndrome related to testicular echogenicity alterations]

OBJECTIVE

This study aims to investigate the relationship between the presence of late-onset hypogonadism (LOH) syndrome in men and alterations in testicular echogenicity in a rural population sample.

MATERIALS AND METHODS

Prospective observational cohort study in which men between 45 and 75 years old from Villarta de San Juan area (Ciudad Real) were included. In order to determine the incidence of HIT, each patient was administered the AMSS test, a blood test to determine the concentration of testosterone, and a bilateral testicular ultrasound was performed.

RESULTS

287 patients were included in the study. The diagnosis of LOH syndrome was established in 9.76% of them. 154 bilateral testicular ultrasounds were performed in which their testicular echogenicity patterns were evaluated. In 72.7% of the cases, alterations could be described in accordance with the standards proposed by the European Academy of Andrology of the year 2022. Testicular echogenicity evaluated by ultrasound demonstrated a sensitivity of 72.7%, a specificity of 78.8%, a negative predictive value of 94.5% and a positive predictive value of 36.4%, for the diagnosis of LOH.

CONCLUSIONS

The determination of testicular echogenicity in patients with suspected LOH syndrome showed much greater specificity than the AMSS test and a similar negative predictive value. Based on its innocuousness and the fact that it is a relatively simple examination from a technical point of view, it could be postulated as a diagnostic tool to be taken into account in the identification of this syndrome.

Evaluating the gonads of left-handed children using ultrasonography and comparing the findings with those of right-handed ones

Hand use varies according to which brain hemisphere is dominant. Early androgen exposure causes right hemisphere dominance. This study is aimed at comparing the testes and ovary sizes of healthy left-handed girls and boys with those of healthy right-handed children and investigating whether or not lateralization affects the gonads. The ovarian and testicular sizes of healthy left- and right-handed boys and girls who were similar in height, weight, and age were compared by ultrasonography. One hundred and eleven (111) children-including 26 left- and 26 right-handed girls and 31 left- and 28 right-handed boys-were included in this study. The mean age of left-handed girls was 77.2 ± 25.3 months, and the mean age of right-handed girls was 74.4 ± 25.2 months. Right transverse diameter (p = 0.004), right longitudinal diameter (p = 0.009), and right ovarian volume (p = 0.020) were larger in left-handed girls above 8 years of age than in left-handed girls below 8 years of age. However, these values were similar in right-handed girls above and below 8 years of age. In right-handed girls, the transverse diameter was larger in the right ovary than in the left ovary (0.014). Other ovarian values were similar. The mean age of left-handed boys was 85.2 ± 41.3 months, whereas the mean age of right-handed ones was 81 ± 41.2 months. Prepubertal and pubertal right- and left-handed boys had similar mean right and left testicular diameters and volumes (p > 0.05).

CONCLUSION

Lateralization affected gonad size in girls. In boys, gonads were not affected by lateralization. Cerebral lateralization may affect the hypothalamic-pituitary-gonadal axis in girls.

WHAT IS KNOWN

• Hand use varies according to which cerebral hemisphere is dominant. Males tend to be more left-handed than females. Brain asymmetry can affect the neuroendocrine axis.

WHAT IS NEW

• Ultrasonographic gonadal dimensions were examined in left-handed and right-handed children. Cerebral lateralization may affect the hypothalamic-pituitary-gonadal axis in girls.

Ultrasound assessment of testicular volume - An interobserver variability study

BACKGROUND

Ultrasonography measurement of the testicles and subsequent calculation of the testicular volume is recommended as a part of a standard scrotal ultrasound examination. The interobserver variability of testicular volume measurement has implications for surgical recommendations. Therefore, this study aimed to investigate the interobserver variability in the measurement of testicular volume.

METHODS

Interobserver variability was established by comparing testicular measurements performed by two observers on the same patient during the same clinical appointment. The observers were blinded to each other's measurements. Testicular volume was calculated using the Lambert formula: length x width x height x 0.71. A total of three observers, A, B and C, participated in the study. The observers had between 4 to 20 years' experience with scrotal ultrasound examinations.

RESULTS

In total, 24 patients' were included (48 testicles). The patient´s mean age was 43 years (range 19-75 years). The overall mean right testicular volume was 19.8 ml (range 7.3-31.6 ml), and the left was 20.1 ml (range 7.1-36.1 ml). The interclass correlation coefficient (ICC) between observer A and B was excellent (ICC= 0.98, CI:0.92-0.99), between observer A and C, was excellent (ICC=0.91, CI: 0.77-0.97) and between B and C good (ICC=0.82, CI:0.51-0.93).

CONCLUSION

Variability in estimating testicular volume is low, with interobserver agreement ranging from good to excellent. Ultrasound provides a highly reproducible tool to determine testicular volume.

Magnetic resonance imaging based deep-learning model: a rapid, high-performance, automated tool for testicular volume measurements

Background

Testicular volume (TV) is an essential parameter for monitoring testicular functions and pathologies. Nevertheless, current measurement tools, including orchidometers and ultrasonography, encounter challenges in obtaining accurate and personalized TV measurements.

Purpose

Based on magnetic resonance imaging (MRI), this study aimed to establish a deep learning model and evaluate its efficacy in segmenting the testes and measuring TV.

Materials and methods

The study cohort consisted of retrospectively collected patient data (N = 200) and a prospectively collected dataset comprising 10 healthy volunteers. The retrospective dataset was divided into training and independent validation sets, with an 8:2 random distribution. Each of the 10 healthy volunteers underwent 5 scans (forming the testing dataset) to evaluate the measurement reproducibility. A ResUNet algorithm was applied to segment the testes. Volume of each testis was calculated by multiplying the voxel volume by the number of voxels. Manually determined masks by experts were used as ground truth to assess the performance of the deep learning model.

Results

The deep learning model achieved a mean Dice score of 0.926 ± 0.034 (0.921 ± 0.026 for the left testis and 0.926 ± 0.034 for the right testis) in the validation cohort and a mean Dice score of 0.922 ± 0.02 (0.931 ± 0.019 for the left testis and 0.932 ± 0.022 for the right testis) in the testing cohort. There was strong correlation between the manual and automated TV (R2 ranging from 0.974 to 0.987 in the validation cohort; R2 ranging from 0.936 to 0.973 in the testing cohort). The volume differences between the manual and automated measurements were 0.838 ± 0.991 (0.209 ± 0.665 for LTV and 0.630 ± 0.728 for RTV) in the validation cohort and 0.815 ± 0.824 (0.303 ± 0.664 for LTV and 0.511 ± 0.444 for RTV) in the testing cohort. Additionally, the deep-learning model exhibited excellent reproducibility (intraclass correlation >0.9) in determining TV.

Conclusion

The MRI-based deep learning model is an accurate and reliable tool for measuring TV.

Effects of alpha-lipoic acid on sperm quality in patients with varicocele-related male infertility: study protocol for a randomized controlled clinical trial

BACKGROUND

Varicocele is a high incidence and is considered to be the most common and correctable cause of male infertility. Oxidative stress (OS) plays a central role in the pathogenesis of varicocele-related male infertility. In addition to varicocelectomy, antioxidant supplementation seems to be an effective scheme for the treatment of varicocele-related male infertility, but it is still controversial. The purpose of this study is to determine the effects of alpha-lipoic acid (ALA) supplementation on sperm quality in patients with varicocele-related male infertility.

METHODS

In this randomized controlled clinical trial, we will randomize 80 patients with varicocele-related male infertility from Guilin People's Hospital. The non-surgical observation group (n = 20) will receive ALA, the non-surgical control group (n = 20) will receive vitamin E, the surgical observation group (n = 20) will receive ALA after the operation, and the surgical control group (n = 20) will receive vitamin E after the operation. The course of treatment will be 3 months. The results will compare the changes in semen parameters, sex hormones, testicular volume, sperm DNA fragment index (DFI), seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) between the groups at baseline and after 3 months of antioxidant supplementation.

DISCUSSION

Whether it is necessary to use antioxidants in varicocele-related male infertility, how potent antioxidants should be used, postoperative application or non-surgical independent application still needs to be explored. This study attempts to compare the effects of two antioxidants (ALA and vitamin E) on sperm quality in patients with varicocele-related male infertility (surgical or non-surgical) and attempted to answer the above questions.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100054958. Registered on 29 December 2021.

Application of real-time shear wave elastography in the assessment of male infertility

BACKGROUND

Shear wave elastography (SWE) is recognized as a suitable imaging modality for identifying and characterizing testicular diseases. Recent exploration of SWE has focused on its feasibility in evaluating histopathological changes in the testicular parenchyma, with researchers increasingly focusing on the relationship between testicular stiffness and male fertility. In this study, we aimed to investigate the diagnostic value of SWE for distinguishing the relationship between spermatogenic defects and testicular stiffness in males of reproductive age.

METHODS

This was a single center, cross-sectional study conducted from July 2017 to December 2019. A total of 1,116 consecutive patients who were voluntarily participating in in-vitro fertilization (IVF)-assisted conception at our hospital were recruited to the study. The cohort included 497 normozoospermia patients (Group I), 335 with normozoospermia and decreased motility and agglutination (Group II), 138 with oligozoospermia (Group III), 105 with non-obstructive azoospermia (Group-NOA), and 41 with obstructive azoospermia (Group-OA). We conducted SWE of each participant's testes and the testicular elastic modulus was calculated. The differences of testicular elastic modulus were compared among groups. Linear regression analysis was conducted to determine the correlation between sperm concentration and either testicular volume or testicular elastic modulus. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic efficiency of the maximum elastic modulus (Emax), mean elastic modulus (Emean), and maximum minus the minimum elastic modulus {E[max-min]}.

RESULTS

The Emax, Emean, and E[max-min] increased gradually in groups I, II, III, and Group-NOA, with statistical differences between groups (P<0.01). Testicular volume was shown to be positively correlated with sperm concentration (r=0.476; P<0.01), while the Emax, Emean, and E[max-min] were negatively correlated with sperm concentration (r=-0.511, -0.357, and -0.524, respectively; P<0.01). The ROC curves were established based on the Emax, Emean, and E[max-min] and were used to distinguish Group-OA from Group-NOA. The areas under the ROC curve (AUCs) were 0.910, 0.863, and 0.900, respectively. We also used ROC curves to distinguish the severe oligozoospermia subgroup and Group-NOA from other groups, for which the AUCs were 0.877, 0.791, and 0.878, respectively.

CONCLUSIONS

The SWE is an effective supplement to routine ultrasound examination and can be used to diagnose and differentiate spermatogenetic dysfunction.