What does an undescended testicle mean?
In undescended testicle, medically Maldescensus testis or cryptorchidism, one or both testicles are not permanently in the scrotum. The testicle is often located in the inguinal canal, less commonly in the abdominal cavity. The key point is that the testicle does not reliably remain down.
To be distinguished from this is the retractile testicle. In this case, an otherwise normally developed testicle is temporarily pulled upwards by a strong cremasteric reflex, but can be brought into the scrotum and remains there at least temporarily. This should also be assessed by a clinician and monitored over time so a true undescended testicle is not missed.
How common is it and what happens in the first months?
An undescended testicle is one of the most common congenital findings in boys. It occurs significantly more often in preterm infants than in term-born children. In the first months of life the testicle may still descend spontaneously, which is why close monitoring is common during this period.
- Checks are particularly important in the first year of life.
- Documentation helps distinguish true changes from normal fluctuations.
- If the testicle remains up permanently, plan early rather than hope for late spontaneous descent.
A clinical guideline registry provides a specialist perspective. Clinical guideline (AWMF): S2k guideline on undescended testicle
Why the position of the testicle is medically relevant
The scrotum has a clear function. It keeps the testicles slightly cooler than core body temperature. This is important long term for the maturation of germ cells and thus for future sperm production.
If a testicle remains higher permanently, it can adversely affect tissue development. In addition, untreated undescended testicles carry an increased risk of later problems. These particularly include impaired fertility and a higher risk of testicular tumours. Early treatment can reduce risks, but does not replace follow-up.
- Unilateral undescended testicle can affect later fertility, often less than bilateral cases.
- Bilateral undescended testicles are generally more relevant for future fertility issues.
- Follow-up checks remain important even if treatment occurs early.
Causes and risk factors
Why a testicle fails to descend fully can have different causes. Often it is a combination of anatomical and hormonal factors. For parents, the important point is: it 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
- Accompanying inguinal hernia or patent processus vaginalis
The right timing: when to wait and when not to
In the first months of life, watchful waiting is often sensible because spontaneous descent is still possible. If the testicle has not reached the scrotum after this period, the likelihood of it resolving without treatment decreases.
- First months: ongoing monitoring is the priority.
- If the testicle is not permanently in the scrotum: plan specialist assessment early.
- Many guidelines recommend surgical correction during the first year of life, and by around 18 months at the latest.
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. This checks whether the testicle is palpable, how high it sits and whether it can be brought into the scrotum. This often already indicates whether a retractile testicle, sliding testicle or a true undescended testicle is present.
- Is the testicle 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 supportive in some situations but does not replace the clinical examination. If a testicle is non-palpable, further diagnostics in paediatric urology will be planned depending on the circumstances.
Treatment: what is most commonly done in practice
The standard treatment is surgical mobilisation and fixation of the testicle in the scrotum, the orchidopexy. The testicle is positioned correctly and secured so that it remains there. Often, any accompanying inguinal hernia or patent processus vaginalis is checked and treated at the same time.
- For a palpable testicle in the groin: orchidopexy via a small incision.
- For a non-palpable testicle: diagnostic and often therapeutic laparoscopy.
- For a very high testicle: staged procedures may be used in individual cases.
Individual planning by experienced paediatric urologists or paediatric surgeons is decisive.
What about hormone treatment?
Hormone therapies are sometimes discussed to trigger descent of the testicle. Their benefit is limited depending on the situation and is assessed differently across guidelines. In many cases surgical correction is preferred because it more reliably secures the testicle in the scrotum.
- If hormones are considered, this should be managed by specialists.
- More important than the method chosen is that no critical time window is lost.
Realistic expectations: what early treatment improves
Early correction improves the conditions for normal tissue development. It also makes later checks easier because the testicle is more accessible in the scrotum. This is important because even after treatment for undescended testicle there can remain an increased risk for certain late consequences.
- Fertility: risks can be reduced, particularly with early treatment, but outcomes remain individual.
- Tumour risk: can be reduced, yet often remains elevated compared with the general population.
- Monitoring: becomes simpler and more reliable because the testicle is easily accessible.
A patient-facing overview of undescended testicles and usual treatment is also available from the NHS. NHS: Undescended testicles
Typical pitfalls that waste time
- A retractile testicle is dismissed without follow-up, even though the testicle increasingly remains high.
- Relying on imaging instead of consistently performing and documenting the clinical examination.
- Follow-up checks after the first half-year are postponed for too long even though the testicle still does not remain in the scrotum.
- For bilateral non-palpable testicles, specialist assessment is not sought 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 usually crucial: pain management, rest and checking that the wound heals well. Details depend on age, initial situation and surgical technique.
- Pain and rest: manageable in the first days, then a gradual return to normal activities.
- Wound care: according to the clinic’s instructions, with clear signs for when to seek review.
- Follow-up checks: to assess position, size and development of the testicle.
- Later, from adolescence: sensible self-examination and early presentation if anything seems unusual.
Costs and practical planning
In many health systems, diagnosis and treatment of undescended testicles are part of routine medical care. Coverage for medically necessary services is usually provided through public or private health schemes depending on the country. For families, practical matters such as travel, caring for siblings and time off work are often most relevant.
- Plan appointments so follow-up is reliably possible.
- Note questions about anaesthesia and the procedure in advance and discuss them at the consent appointment.
- After the operation, allow enough rest and support for the first days.
For an overview of hospital services and co-payments this official information page may be helpful. Overview of hospital services and co-payments
Legal and organisational context
Assessment of testicle position is part of early child health checks. Organisation and documentation of these checks vary by country; for example, some systems include routine child health reviews with standard record-keeping. For medically necessary procedures, guardians decide after informed consent and practical arrangements are usually managed through referral and appointment scheduling in specialist care.
Regulations on screening, reimbursement, consent and follow-up differ internationally. If you live or are treated abroad, it is worth asking about local standards and timeframes and taking all findings with you. A concise overview of child health screening is available from national health authorities. Overview of child health screening
When you should seek medical advice
If a testicle in a baby or young child is not palpable in the scrotum, it should be examined by a paediatrician in a timely manner, even if the child has no symptoms. The same applies if the testicle no longer reliably stays down or if it is unclear whether it is a retractile testicle.
- One or both testicles are not permanently palpable in the scrotum.
- The testicle appears smaller, higher or noticeably different compared with the other side over time.
- You feel the testicle is down less and less often.
Immediate assessment is necessary if severe acute scrotal pain occurs, if swelling appears suddenly, or if the child becomes very unwell. In those cases an acute scrotum must be excluded.
Conclusion
Undescended testicles are common and often unremarkable at first. Precisely for that reason they are a matter of good preventive care, clear documentation and reliable timeframes. Many cases may normalise in the first months; after that, early planning becomes more important.
The best strategy is calm and consistent: have the child examined, monitor the course, refer to specialists early if descent does not occur and do not delay treatment unnecessarily.
