Strain elastography for fertility assessment after pediatric testicular torsion: A long-term follow-up study

INTRODUCTION: Testicular torsion (TT) is a urological emergency characterized by the twisting of the spermatic cord, leading to ischemia and potential testicular damage. If not treated promptly, TT can result in testicular atrophy and infertility. While early surgical intervention restores blood flow, the long-term impact on fertility remains a concern. This study investigates the role of strain elastography (SE) and testicular volume measurements in assessing testicular function after TT. OBJECTIVE: To evaluate the importance of strain elastography and testicular volume measurements in the long-term fertility assessment of adolescent patients who underwent surgery for TT. STUDY DESIGN: This retrospective observational study included 15 patients operated on for TT between 2014 and 2020. Data on patient demographics, age at surgery, torsion laterality, symptom duration, degree of torsion, follow-up period, and semen analysis results were collected. SE and testicular volume measurements were performed during follow-up. Patients were classified as fertile or subfertile based on semen analysis. Statistical analyses were conducted using SPSS, including independent sample t-tests and Pearson correlation analysis. RESULTS: The volume of the torsed testis was significantly reduced compared to the contralateral testis (p = 0.0001). In the fertile group, there was a strong correlation between the affected and contralateral testis elastography values (r = 0.948), whereas this correlation was weak in the subfertile group (r = 0.158). The results suggest that in the fertile group, both testicles exhibited similar elastographic changes, while in the subfertile group, the affected testis showed independent variations. CONCLUSION: This study highlights the importance of strain elastography and testicular volume measurements in the long-term assessment of fertility following TT. These techniques provide valuable insights into testicular function and potential fertility. Further research with larger cohorts and extended follow-up is needed to validate these findings.