Testicular shear-wave elastography in adult varicocele: associations with semen quality and clinical parameters

Varicocele is a common cause of impaired semen quality, yet the relationship between testicular shear-wave elastography (SWE) and functional reproductive outcomes remains unclear. This study aimed to evaluate SWE-derived testicular stiffness in adult patients with varicocele and its association with semen quality and selected clinical parameters.

In this prospective observational study, 109 adult men (age range: 18-50 years; mean age: 28.6 ± 6.6 years) with left-sided varicocele were enrolled between December 2024 and January 2025. All patients underwent standardised scrotal ultrasonography, SWE of both testes at rest and during the Valsalva manoeuvre, and World Health Organization (WHO)-based semen analysis. Testicular stiffness, volume, venous diameter, and clinical and ultrasonographic varicocele grades were recorded. Associations between SWE measurements and semen abnormalities were assessed using correlation analyses, group comparisons, and effect-size statistics.

Mean SWE values were higher in the left testis than in the right testis at rest (8.37 ± 2.77 vs 7.68 ± 1.82 kPa) and during Valsalva (8.94 ± 3.45 vs. 8.38 ± 2.40 kPa). Left-sided SWE measurements were significantly associated with semen abnormalities (P < 0.05) and showed the largest effect sizes among imaging parameters (ε² ≈ 0.22-0.26). Testicular volume showed weaker associations, while clinical and ultrasonographic varicocele grades demonstrated limited discriminatory value.

Testicular SWE is associated with semen quality in adult varicocele, particularly on the left side; however, stiffness alone is not a strong standalone marker of clinical severity. SWE may provide complementary functional information when interpreted alongside conventional clinical and ultrasonographic findings.