Intratesticular Doppler Flow and Gonadal Status in Male Survivors of a Childhood Malignancy

Aim of the study was to assess the effect of chemo-radiotherapy on gonadal function in males treated for childhood malignancies, adding ultrasonographic and colour Doppler (cD) scanning of the testes to hormonal evaluation. cD allows the measurement of impedence to flow in intratesticular vessels: high transmediastinal artery pulsatility index (TMA PI) values express low testicular vascularization. Fifty patients (pts.) were studied: 15 Hodgkin’s Disease (HD) pts., 17 non Hodgkin’s Lymphoma (NHL) pts., 7 acute lymphoblastic leukemia (ALL) pts. 7 pts. treated with high-dosage alkylating agents for bone marrow transplantation (BMT) and 4 ALL pts. with testicular relapse submitted to radiotherapy, were considered apart. Mean age at diagnosis was 10.5±3.4 yrs; mean time elapsed from stop therapy 9.5±5.3 yrs. All the patients were Tanner stage V at examination (mean age 20±4.4 yrs). 11 healthy fertile males served as control group. FSH, LH and testosterone (T) levels were determined. Scrotal ultrasound assessment of testicular volume (tVol) was performed using a 7.0 MHz linear probe; for Doppler flow measurements of TMA a 6.5 MHz cD system was used. FSH, LH and TMA PI values of BMT pts., irradiated pts., and HD pts. treated with COPP-ABV protocols were significantly higher than controls. NHL pts. showed only higher TMA PI values; LLA pts. and HD pts. treated with ABVD protocols did not differ from controls. In the study population, tVol was inversely correlated with FSH (r=-0.68; p<0.0001) and LH (r=-0.51; p<0.0001), and directly correlated with T (r=0.43; p<0.005). Furthermore, TMA PI was inversely correlated with tVol (r= -0.51; p<0.0001) and directly correlated with FSH (r= 0.41; p<0.005). The cD analysis of TMA PI seems to be a useful diagnostic tool for the evaluation of testicular damage, in addition to hormonal and clinical evaluation.