| Abstract | Cilj: Utvrditi kako je infracrvena termografija skrotuma dijagnostička metoda koja može dijagnosticirati recidiv nakon operacije varikokele. Ispitanici i metode: Studija je ustrojena na temelju prospektivnog istraživanja. Ispitanici su pregledani i liječeni kroz urološku ambulantu Odjela za urologiju Opće bolnice „Dr. Josip Benčević“ Slavonski Brod. Istraživanje je provedeno na 38 ispitanika liječenih u razdoblju od 2010. do 2017.godine. Protokol istraživanja obuhvaća: 1. Dijagnostika primjenom moderne termografske kamere uz analizu slika u odgovarajućem računalnom programskom paketu. 2. Klinički pregled. 3. Dijagnostika ultrazvukom s color Dopplerom. 4. Ponovna dijagnostika primjenom termografije, kliničkog pregleda i ultrazvuka s color Dopplerom dva ili više mjeseci nakon operativnog zahvata. Rezultati: Pozitivan klinički nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 33 (87 %) ispitanika. Prije zahvata kliničkim pregledom 31 (82 %) ispitanik imao je III. stupanj varikokele, a 7 (23 %) ispitanika imalo je II. ili II/III. stupanj varikokele. Nakon zahvata došlo je do značajnog poboljšanja, odnosno III. stupanj i II/III. stupanj varikokele ima sedam (19 %) ispitanika, dok ih je najviše, njih 16 imalo (42 %) I. stupnja, a kod pet (13 %) ispitanika bilježi se uredan nalaz (Test marginalne homogenosti, P < 0,001). Pozitivan termografski nalaz prije operacije nalazimo kod 37 (97 %) ispitanika, a poslije operacije pozitivan termografski nalaz ima 7 (18 %) ispitanika (McNemarov test, P < 0,001). Pozitivan ultrazvučni nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 13 (34 %) ispitanika. Konglomerat vena lijeve strane uočava se prije operacije kod 25 (66 %) ispitanika, obostrano kod tri (8 %) ispitanika. Poslije operacije konglomerat vena lijeve strane bilježi se kod devet (24 %) ispitanika, po jedan (3 %) ispitanik bilježi konglomerat vena obostrano. 57 Uspoređujući nalaz infracrvene termografije s kliničkim nalazom nakon operacije, uočava se da je prema kliničkom nalazu nakon operacije još uvijek 33 (87 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih sedam (18 %), što je značajna razlika (McNemarov test, P < 0,001). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, ne možemo reći da postoji slaganje u metodama (Cohenov Kappa k = 0,07 uz 95 % CI od -0,01 do 0,14). Nakon operacije uspoređujući UZV nalaz s nalazom infracrvene termografije, uočava se da je prema UZV nalazu nakon operacije još uvijek 13 (34 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih 7 (18 %) (McNemarov test, P = 0,03) (mjereno prema termografiji uz osjetljivost od 100 %, specifičnost od 80,6 %). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, možemo reći da postoji značajno umjereno slaganje između UZV i termografskog nalaza (Cohenov Kappa k = 0,606 uz 95% CI od 0,339 do 0,872; P < 0,001) . Uspoređujući klinički nalaz s nalazom UZV-a, uočavamo da je značajno više ispitanika nakon operacije prema kliničkom nalazu pozitivno u odnosu na UZV nalaz. U usporedbi prema UZV nalazu osjetljivost kliničkog nalaza nakon operacije je 92,3 %, a specifičnost 16 %. Uočavamo da nakon operacije nema značajnog slaganja između kliničkog i UZV nalaza (Cohenov Kappa test k = 0,061, P = 0,64) Na osnovi ispunjenih kriterija značajno je smanjenje u broju ispitanika s konačnom dijagnozom varikokele nakon operacije, odnosno smanjenje je od 37 (97 %) ispitanika s pozitivnim termografskim nalazom prije operacije na sedam (18 %) ispitanika poslije operacije (McNemarov test, P < 0,001). Zaključak: Istraživanje je potvrdilo termografske kriterije kao dobro odabrane za adekvatno postavljanje dijagnoze varikokele te da se navedeni kriteriji mogu i trebaju koristiti u tumačenju snimaka skrotalne infracrvene termografije kako prije tako i poslije operativnog zahvata. Infracrvena termografija u usporedbi s kliničkim pregledom pokazala se kao statistički signifikantno bolje dijagnostička metoda za dijagnostiku recidiva varikokele. Pokazala je znatnu korist u dijagnostici recidiva nakon operacije varikokele, dok je klinički pregled imao veliku stopu lažno pozitivnih nalaza. Infracrvena termografija u usporedbi s UZV color Dopplerom pokazala se kao metoda koja ima 58 statistički signifikantno bolji rezultat, ali možemo reći i da imaju značajno umjereno slaganje. Infracrvena termografija je ovim istraživanjem pokazala dijangostičku vrijednost u dijagnostici recidiva varikokele. Pokazalo se kako u usporedbi s kliničkim pregledom i/ili UZV-om termografija ima bolju osjetljivost i specifičnost. |
| Abstract (english) | Objective: To determine that infrared scrotal thermography is a diagnostic method that can diagnose recurrence after varicocele surgery. Subjects and methods: The study was structured based on a prospective research. Subjects were examined and treated through the urology clinic of the Department of Urology of the General Hospital "Dr. Josip Benčević" Slavonski Brod. The research was conducted on 38 subjects treated in the period from 2010 to 2017. .Research protocol includes: 1. Diagnostics using a modern thermographic camera with image analysis in the appropriate software package 2. Clinical examination 3. Ultrasound diagnosis with color Doppler 4. Two or more months after surgery, re-diagnosis using thermography, clinical examination and ultrasound with color Doppler. The results: All subjects had a positive clinical finding before surgery, while it was positive after surgery in 33 (87%) subjects. Before the procedure, 31 (82%) subjects had III. degree of varicocele, and 7 (23%) subjects had II. or II / III. degree of varicocele. After the procedure, there was a significant improvement, i.e. III. degree and II / III. the degree of varicocele has 7 (19%) subjects, while most of them, 16 (42%) I. degree, and 5 (13%) subjects recorded a regular finding (Marginal homogeneity test, P <0.001). Positive thermographic findings before surgery were found in 37 (97%) subjects, and after surgery negative thermographic findings were found in 7 (18%) subjects (McNemar test, P <0.001). All subjects had a positive ultrasound finding before surgery, while it was positive after surgery in 13 (34%) subjects. Left vein conglomerate is noticed before surgery in 25 (66%) subjects, bilaterally in 3 (8%) subjects. After the operation, left vein conglomerate was noticed in 9 (24%) subjects, and one (3%) subject recorded venous conglomerate on both sides. 60 Comparing the finding of infrared thermography with the clinical finding after surgery, it is noticed that according to the clinical finding after surgery there are still 33 (87%) subjects with a positive finding, while according to the thermographic finding positive 7 (18%), which is a significant difference test, P <0.001). Comparing these two methods with respect to the finding after surgery, one cannot say that there is agreement in the methods (Cohen's Kappa k = 0.07 with 95% CI from -0.01 to 0.14). After the operation, comparing the ultrasound finding with the infrared thermography finding, it is noticed that according to the ultrasound finding after the operation, there are still 13 (34%) subjects with a positive finding, while according to the thermographic finding, 7 (18%) are positive (McNemar test, P = 0 , 03) (measured by thermography with a sensitivity of 100%, a specificity of 80.6%). Comparing these two methods with respect to the postoperative finding, one can say that there is a significant moderate agreement between ultrasound and thermographic findings (Cohen's Kappa k = 0.606 with 95% CI from 0.339 to 0.872; P <0.001). Comparing the clinical finding with the ultrasound finding, we notice that significantly more subjects after surgery according to the clinical finding are positive compared to the ultrasound finding. Compared to ultrasound findings, the sensitivity of the clinical finding after surgery is 92.3% and the specificity is 16%. We note that, after surgery, there is no significant agreement between clinical and ultrasound findings (Cohen's Kappa test k= 0.061, P = 0.64) Based on the fulfilled criteria, there is a significant decrease in the number of subjects with a final diagnosis of varicocele after surgery, ie a decrease from 37 (97%) subjects with a positive thermographic finding before surgery to 7 (18%) subjects after surgery (McNemar test, P <0.001). Conclusion: The study confirmed the thermographic criteria as well selected for adequate diagnosis of varicocele and that these criteria can and should be used in the interpretation of scrotal infrared thermography images both before and after surgery. Infrared thermography compared to clinical examination proved to be a statistically significantly better diagnostic method for the diagnosis of varicocele recurrence. It showed significant benefit in the diagnosis of recurrence after varicocele surgery, while the clinical examination had a high rate of false-positive findings. Infrared thermography 61 compared to color Doppler proved to be a method that has a statistically significantly better result, but we can also say that they have a significantly moderate agreement. With this research, infrared thermography showed a diagnostic value in the diagnosis of varicocele recurrence. Thermography has been shown to have better sensitivity and specificity compared to clinical examination and / or ultrasound. |
