Background <p>Varicocele (VC) is a significant contributor to both primary and secondary male infertility. VC can lead to progressive, time-dependent damage to testicular function, as demonstrated in both animal and human studies. To assess testicular tissue alterations, we conducted the first systematic review and meta-analysis on the effects of VC on testicular stiffness and volume. A literature search was conducted in June 2024 without language or geographic restrictions. The search included the databases PubMed, Embase, and Medline. We reviewed the literature to identify all published clinical trials using shear wave elastography (SWE) to evaluate the stiffness and volume of varicocele-affected and normal testes. The reference lists of the retrieved studies were examined. We conducted a systematic review and meta-analysis.</p> Results <p>Seven articles, encompassing 1118 testes, were selected from a pool of eighty-seven. The analysis revealed that the stiffness of varicocele-affected ipsilateral testes was higher than that of normal testes (<i>p</i> &lt; 0.05), and the stiffness of normal testes was higher than that of contralateral testes (<i>p</i> &lt; 0.05). Regarding volume, the varicocele-affected ipsilateral testes were smaller than the contralateral testes (<i>p</i> &lt; 0.05), with no significant difference between the contralateral and normal testes (<i>p</i> &gt; 0.05).</p> Conclusions <p>This meta-analysis indicates that VC impacts the stiffness and volume of both testes. SWE is an effective technique for assessing testes affected by VC, but a large-scale, multicenter randomized controlled study is needed for further confirmation.&#xa0;</p>