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Slide 2 P R E S E N T A T I O N The general experience with Sono-Elastography is growing with time, thus we have built the meeting as an occasion to share current knowledge and advances in this field. Sono-Elastography adds valuable information to the study of all organs, potentially resulting in a virtual biopsy. Because different elastographic modalities are available, our aim is also to help understanding which one is best suited for any given indication and which information can be obtained when using it. The Scientific Committee Fabrizio Calliada, Mario Canepari, Giovanna Ferraioli, Carlo Filice Slide 3 Antonio Pio Masciotra Campobasso Molise Italy Email antoniomasciotra@yahoo.it Website www.masciotra.net YouTube Channel https://www.youtube.com/channel/ UCgCj21nKGAhR997Ia3-QegQ Sonoelastography of the testis Slide 4 EFSUMB Guidelines and Recommendations on clinical use of US Elastography takes only five lines to pursue the testis issue, then limited to a very rare tumor. Instead Ill try to describe the use of US elastography in the most prevalent diseases of the testis highlighting its distinctive contribution to their clinical workup. Slide 5 Topics in clinical use of Sonoelastography in non neoplastic diseases of the testis dr. Antonio Pio Masciotra Campobasso- Molise - Italy Slide 6 The social impact of the diseases of the testis in Italy Slide 7 Testis disease clinical case Undescended testis Man 35 years old Left testis undescended at birth Left orchiopexy at age of 14 years Then infertility Slide 8 Right testis Volume 10,89 cc kPa : 2,2 Left testis Volume 04,26 cc kPa : 5,0 Slide 9 Key points and take home messages The left testis previously undescended and operated too late shows loss of volume and inhomhogeneous texture These alterations correspond to increased stiffness (Left 5,0 kPa Vs Right 2,2 Kpa) and the patient is infertile Final consideration and Question Could SW Elastography with its tissue stiffness quantification be used as a reliable indicator of tissue viability and functionality in the undescended testis to choose the optimal timing of orchiopexy? Slide 10 Testis disease clinical case Varicocele Man 25 years old Normally descended testes at birth Three years before operated for left testis torsion ten hours after the beginning of the symptoms Preserved fertility (2.5 years after the operation he had a baby!) Slide 11 Left testis Slide 12 Slide 13 Left testis Mean Stiffness 2.2 kPaRight testis Mean Stiffness 3.0 kPa Slide 14 Key points and take home messages The left testis shows loss of volume, scant vessels and inhomhogeneous texture as consequences both of previoius torsion and of varicocele Despite these alterations, it preserves normal stiffness (left 2.2 kPa Vs Right 3.0 Kpa) and the patient is still fertile Final consideration and Question Could SW Elastography with its tissue stiffness quantification be used as a reliable indicator of tissue viability and functionality at least in the varicocele to identify the cases to be treated usefully? Slide 15 New topics in clinical use of Sonoelastography in non neoplastic diseases of the testis It could be useful to explore its utility in : 1) predicting if varicocele will have favourable response to treatment 2) predicting if and how much the testis can 'rescue' after treatment. 3) guiding the best timing in the surgery of undescended or ascensus-retractile testes. Personal comment : I've the impression that orchiopexy had to be done between 10 months and 2 years of age, without the delay induced by hormonal therapy, too often unsuccessfull or not resolutive (efficacy