Indeterminate nonpalpable focal testicular lesions have emerged as a clinical problem with the increasing use of scrotal ultrasound, particularly in the context of infertility. Conventional morphological ultrasound and color Doppler have been unreliable at differentiating benign from malignant lesions. Multiparametric ultrasound (mpUS) comprises real-time elastography and contrast-enhanced ultrasound as adjunctive tools, and is ready for use in most state-of-the-art ultrasound systems. Initial experience with mpUS from selected specialist centers shows promise for lesion characterization, and potential for affecting management and improving outcomes. This article provides a summary of the existing literature on testicular mpUS, and outlines the clinical context from a urological and histopathological perspective.