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Simple Summary: In our retrospective study at a tertiary centre, we reviewed the use of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) as adjuncts to conventional greyscale and colour Doppler US (CDUS) for evaluating focal testicular abnormalities over a decade. This study highlights the potential of advanced ultrasound techniques to provide deeper insights into the characteristics of testicular abnormalities. In particular, we observed that contrast-enhanced ultrasound could detect vascular enhancement in all malignant cases, even those not identified by conventional CDUS, and more conclusively confirm benignity. While SE alone offered no distinctive advantage, incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities improved diagnostic performance metrics over conventional CDUS. Our research underscores the enhanced performance achieved by utilising these advanced ultrasound techniques. The comprehensive diagnostic assessment provided by these techniques could facilitate a shift towards more conservative management of testicular lesions, supporting the preference for organ-preserving methods over more radical surgeries. Conventional ultrasonography (US), including greyscale imaging and colour Doppler US (CDUS), is pivotal for diagnosing scrotal pathologies, but it has limited specificity. Historically, solid focal testicular abnormalities often led to radical orchidectomy. This retrospective study evaluated the utilisation of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) in investigating intratesticular focal abnormalities. A total of 124 cases were analysed. This study underscored the superior diagnostic capabilities of CEUS in detecting vascular enhancement in all malignant cases, even those with undetectable vascularity by CDUS. It also highlighted the potential of CEUS in identifying distinctive vascular patterns in benign vascular tumours. Definitive confirmation of benignity could be obtained when the absence of enhancement was demonstrated on CEUS. While SE alone offered no distinctive advantage in differentiating between benign and malignant pathologies, we demonstrated that incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities could improve diagnostic performance metrics over conventional CDUS. Our findings underscore the role of advanced ultrasound techniques in enhancing the evaluation of focal testicular abnormalities in clinical practice and could aid a shift towards testis-sparing management strategies. [ABSTRACT FROM AUTHOR]