Testicular Stiffness and Volume in Varicocele Patients: A Prospective Comparative Shear Wave Elastography Study

<b>Background/Objectives</b>: A varicocele is a common, treatable cause of male infertility involving testicular alterations. Shear wave elastography (SWE) is a noninvasive imaging technique that may detect testicular changes. This study aimed to assess the testicular volume and stiffness (using SWE), compare them with healthy controls, and examine the associations with venous diameter and semen parameters. <b>Methods</b>: This prospective comparative study included 69 patients with a varicocele and 76 healthy controls. The testicular stiffness and volume were measured and compared among three groups: testes with a varicocele (Group A), contralateral healthy testes of the same patients (Group B), and testes of healthy individuals (Group C). In varicocele patients, the semen analysis results were compared with testicular stiffness and volume. The statistical analyses included an ANOVA, Kruskal-Wallis tests, a correlation analysis, and a receiver operating characteristic curve analysis. <b>Results</b>: Group A showed a significantly lower testicular volume compared to Group B (<i>p</i> = 0.004) and Group C (<i>p</i> < 0.001), and significantly higher SWE values compared to both groups (<i>p</i> < 0.001). No significant differences were observed between Group B and Group C (volume: <i>p</i> = 0.642; SWE: <i>p</i> = 0.094). In oligospermic varicocele patients, the testicular stiffness tended to be higher, though the difference was not significant (<i>p</i> = 0.051). The correlations between the testicular stiffness and volume (Group A: <i>p</i> = 0.488; Group B: <i>p</i> = 0.872; Group C: <i>p</i> = 0.222), between the venous diameter and stiffness (<i>p</i> = 0.067), and between the venous diameter and testicular volume (<i>p</i> = 0.245) were not statistically significant. The SWE cut-off value of 9.26 kPa provided a sensitivity of 73.1% (95% CI: 62.3-81.7%) and a specificity of 79.6% (95% CI: 72.5-85.2%) for identifying varicoceles. <b>Conclusions</b>: Varicoceles are associated with an increased testicular stiffness and a decreased volume, which may indicate possible structural parenchymal alterations. Shear wave elastography appeared to be capable of noninvasively detecting these changes and may have potential as a quantitative adjunct tool for evaluating testicular parenchymal changes in varicocele patients. However, further studies are required to validate these preliminary findings.