What does undescended testis mean?
In an undescended testis, medically called maldescensus testis or cryptorchidism, one or both testes are not permanently in the scrotum. Often the testis is located in the inguinal canal, less commonly in the abdomen. The key point is that the testis does not reliably remain in the scrotum.
This is distinct from a retractile testis. In that case, an otherwise normally formed testis is temporarily pulled upward by a strong muscle reflex but can be brought into the scrotum and remains there at least for a time. This too should be assessed by a doctor and monitored over time so that a true undescended testis is not overlooked.
How common is it and what happens in the first months?
An undescended testis is one of the most common congenital findings in boys. It is considerably more frequent in preterm infants than in full-term newborns. In the first months of life the testis can still descend spontaneously, which is why close monitoring is often performed during this period.
- Checks are especially important during the first year of life.
- Documentation helps distinguish true changes from normal variability.
- If the testis remains persistently high, plan early rather than hoping for late spontaneous descent.
A German-language clinical perspective is available in the guideline registry. S2k guideline on undescended testis (AWMF)
Why the position of the testis is medically relevant
The scrotum has a clear function. It keeps the testes slightly cooler than core body temperature. This is important long-term for maturation of germ cells and later sperm production.
If a testis remains higher permanently, tissue development can be adversely affected. In addition, untreated undescended testis is associated with an increased risk of later problems, notably reduced fertility and an elevated risk of testicular tumours. Early treatment can reduce these risks but does not replace ongoing follow-up.
- Unilateral undescended testis can affect later fertility, often less so than bilateral cases.
- Bilateral undescended testis is generally more relevant for later fertility issues.
- Follow-up checks remain important even when treatment occurs early.
Causes and risk factors
There are different reasons why a testis does not fully descend. Often it is a combination of anatomical and hormonal factors. For parents it is important to know: this is rarely caused by behaviour during pregnancy and is generally not influenced by care or positioning at home.
- Premature birth
- Low birth weight
- Family history
- Associated inguinal hernia or patent processus vaginalis
The right timing: when waiting makes sense and when it does not
In the first months of life, waiting is often reasonable because spontaneous descent is still possible. If the testis has not reached the scrotum after this period, the likelihood of reliable spontaneous normalisation without treatment decreases.
- First months: monitoring the course is the priority.
- If the testis is not permanently in the scrotum: plan specialist assessment early.
- Many guidelines recommend surgical correction during the first year of life, at the latest by about 18 months of age.
The European guideline perspective summarises the approach in a structured way. EAU: Paediatric urology guideline chapter
How the assessment typically proceeds
The most important basis is the physical examination. The clinician will check whether the testis is palpable, how high it sits and whether it can be brought into the scrotum. This often already indicates whether a retractile testis, an ascending testis or a true undescended testis is present.
- Is the testis palpable or non-palpable?
- Can it be brought into the scrotum, and does it remain there?
- Are there signs of an inguinal hernia or other accompanying findings?
Ultrasound can be complementary in some situations but does not replace the examination. If a testis is non-palpable, further diagnostics in paediatric urology will be planned depending on the situation.
Treatment: what is most commonly done in practice
The standard treatment is surgical relocation and fixation of the testis in the scrotum, the orchidopexy. The testis is placed in the correct position and secured so it remains there. Often any inguinal hernia or patent processus vaginalis is assessed and treated at the same time.
- For a palpable testis in the groin: orchidopexy through a small incision.
- For a non-palpable testis: diagnostic and therapeutic laparoscopy is frequently used.
- For very high-lying testes: staged procedures are used in some cases.
Individual planning by experienced paediatric urology or paediatric surgery teams is crucial.
What about hormone treatment?
Hormone therapies are sometimes discussed to stimulate descent of the testis. Their benefit is limited in some situations and is assessed differently across guidelines. In many cases surgical correction is preferred because it more reliably places the testis in the scrotum.
- If hormones are considered, this should be done by specialists.
- More important than the specific method is that no treatment window is lost.
Realistic expectations: what early treatment improves
Early correction improves the conditions for normal tissue development. It also makes later examinations easier because the testis is more readily palpable in the scrotum. This matters because even after treatment there can be an elevated risk for certain long-term outcomes.
- Fertility: risks can be reduced, especially with early treatment, but outcomes remain individual.
- Tumour risk: can be reduced, but often remains elevated compared with the general population.
- Follow-up: becomes easier and more reliable because the testis is accessible.
A patient-oriented overview of undescended testicles and common treatment is also available from the NHS. NHS: Undescended testicles
Typical pitfalls that waste unnecessary time
- A retractile testis is dismissed as harmless without follow-up, even though the testis may increasingly remain high.
- Relying on imaging rather than consistently performing the examination and documentation.
- Follow-up checks are postponed too long after the first half-year, even though the testis is still not permanently in the scrotum.
- In bilateral non-palpable testes, specialist assessment is not organised early enough.
At its core the logic is simple: the early months allow for spontaneous normalisation; after that reliable planning becomes more important.
Follow-up and safety around the operation
An orchidopexy is usually performed under general anaesthesia. For parents, the days after the operation are most important: pain management, rest and checking that the wound is healing well. The details depend on age, initial situation and surgical technique.
- Pain and rest: expected in the first days, followed by gradual return to normal activities.
- Wound care: according to the clinic's instructions, with clear warning signs for review.
- Follow-up visits: to check position, size and development of the testis.
- Later from adolescence: sensible self-examination and earlier presentation for any concerns.
Costs and practical planning in Canada
In Canada, diagnosis and treatment of an undescended testis are generally part of routine medical care. For publicly insured residents, medically necessary services are typically covered by provincial health plans. Organisationally, families are often more affected by travel, sibling care and time off work.
- Plan appointments so that follow-up is feasible.
- Note questions about anaesthesia and the procedure in advance and raise them at the consent discussion.
- Arrange adequate rest and support for the first days after surgery.
For an overview of hospital services and potential fees see official Canadian resources. Canada.ca: Hospital services and fees
Legal and organisational context in Canada
Assessment of testicular position is part of early paediatric care. In Canada, well-child checks and screening programs are organised at provincial and territorial levels and include documentation in health records. For medically necessary procedures, guardians provide informed consent after a discussion; practical coordination is usually handled through referral and appointment systems in specialised care.
Regulations on screening, cost coverage, consent and follow-up vary significantly between countries and provinces. If you live or are treated abroad, check local standards and timelines and take all findings with you. A concise overview of early childhood screening is available through federal resources. Health Canada: Early childhood screening
When you should seek medical advice
If a testis in a baby or young child is not palpable in the scrotum, it should be checked by a paediatrician in a timely manner, even if the child has no symptoms. The same applies if the testis no longer reliably remains down over time or if it is unclear whether it is retractile.
- One or both testes are not consistently palpable in the scrotum.
- The testis appears higher, smaller or otherwise different compared with the other side.
- You notice that the testis is down less and less often.
Immediate assessment is required if there is severe acute scrotal pain, sudden swelling, or if the child appears very unwell. In those cases an acute scrotum must be excluded.
Conclusion
Undescended testis is common and often initially unremarkable. Precisely for that reason it should be addressed with good preventive checks, clear documentation and reliable timelines. Much can normalise in the first months; afterwards early planning becomes more important.
The best strategy is calm and consistent: have it examined, monitor the course, refer early to specialists if descent does not occur, and do not delay treatment unnecessarily.
