Evaluation of the potential role of shear wave elastography as a promising predictor of sperm retrieval in non‐obstructive azoospermic patients: A prospective study

Background and Objectives Testicular sperm extraction (TESE) has been a useful diagnostic and therapeutic tool with sperm retrieval opportunity varying according to the pathological finding in azoospermic patients. Sonoelastography (SE) is an exciting radiologic method that can measure relative elasticity of different tissues in a selected region of interest (ROI) by depending on fast cross‐correlation technique and a combined autocorrelation method. Real‐time elastography (RTE) can be used for structural analysis of testicular tissue to detect pathological tissue alterations. We aimed in the current study to evaluate the efficacy of shear wave elastography (SWE) in predicting sperm retrieval in non‐obstructive azoospermic (NOA) patients undergoing TESE. Patients and methods This prospective study included 50 NOA patients who did two successive semen analyses with normal or elevated gonadotrophic hormones. All participants were subjected to SWE imaging on the testes by a radiologist. The measurements were recorded in terms of kPa using the SWE mode. They were done on each testis in the longest longitudinal plane. SWE images were viewed using dual mode: elasticity mode (kPa) and propagation (arrival time contour) mode then patients underwent TESE. Results A significant difference in SWE values was observed between patients with successful sperm retrieval and those with negative sperm retrieval providing 94.7% negative predictive value and 50.0% positive predictive value for sperm retrieval in NOA patients undergoing TESE with 75.0% sensitivity and 85.71% specificity (p = 0.0001). Mean stiffness index measured by SWE correlated significantly with the histopathological types as 8 patients only were diagnosed as having severe hypospermatogenesis. Discussion and Conclusion These prime data suggest that SWE as a non‐invasive, easily applicable, and repeatable imaging method has a promising potential to be one of the reliable sonographic modalities that can be used as one of the predictors for sperm retrieval in NOA patients.