What is an undescended testicle?
In an undescended testicle, medically called maldescensus testis or cryptorchidism, one or both testes are not permanently located in the scrotum. Often the testis lies in the inguinal canal, less commonly in the abdomen. The key point is that the testis does not reliably remain in the scrotum.
This should be distinguished from a retractile testis. In that case a otherwise normally formed testis is temporarily pulled up by a strong cremasteric reflex, but can be brought into the scrotum and remains there at least temporarily. This also should be assessed by a doctor and followed over time so that 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 much more often in preterm infants than in full-term babies. In the first months of life the testis can still descend spontaneously, which is why close follow-up is common during this phase.
- Checks are particularly important in the first year of life.
- Documentation helps to distinguish true changes from normal fluctuations.
- If the testis remains permanently high, plan early rather than hope for late spontaneous descent.
For a specialist perspective in German-language guidelines see clinical guidance resources. ICMR/AIIMS: Clinical guidance on undescended testicles
Why the position of the testis is medically relevant
The scrotum has a clear function. It keeps the testes somewhat cooler than core body temperature. This is important in the long term for the maturation of germ cells and thus for later sperm production.
If a testis remains permanently higher, it can adversely affect tissue development. In addition, untreated undescended testicle is associated with increased risks later in life. These include particularly reduced fertility and a higher risk of testicular tumours. Early treatment can reduce risks, but it 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 later fertility concerns.
- Follow-up checks remain important even if treatment is performed early.
Causes and risk factors
There are different reasons why a testis may not descend fully. 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 routine 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 that it will normalise without treatment decreases.
- Early months: follow-up is the priority.
- If the testis does not remain permanently in the scrotum: plan specialist referral early.
- Many guidelines recommend surgical correction during the first year of life, at the latest by around 18 months of age.
An international guideline perspective summarises the approach in a structured way. International guidelines (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 lies and whether it can be brought into the scrotum. From this it is often already possible to determine whether a retractile testis, a sliding testis or a true undescended testicle is present.
- Is the testis palpable or non-palpable?
- Can it be brought into the scrotum, and does it stay there?
- Are there signs of an inguinal hernia or other accompanying findings?
Ultrasound can be useful in some situations but does not replace the clinical examination. If a testis is non-palpable, further diagnostics in paediatric urology are 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, called orchidopexy. During this procedure the testis is placed in the correct position and fixed so that it remains there. Often the operation also includes assessment and treatment of an inguinal hernia or patent processus vaginalis.
- For a palpable testis in the groin: orchidopexy through a small incision.
- For a non-palpable testis: diagnostic and often therapeutic laparoscopy is commonly used.
- For a very high testis: staged procedures are used in selected cases.
Individual planning by experienced paediatric urology or paediatric surgery teams is essential.
What about hormonal treatment?
Hormone therapies are sometimes discussed to stimulate descent of the testis. Their benefit is limited in some situations and guidelines differ in their recommendations. In many cases surgical correction is preferred because it more reliably establishes the testis in the scrotum.
- If hormones are considered, this should be done by specialists.
- More important than the method is that no critical time window is lost.
Realistic expectations: what early treatment can improve
Early correction improves the conditions for normal tissue development. It also makes later checks easier because the testis in the scrotum is easier to palpate. This matters because after an undescended testicle there can remain an increased risk for certain long-term consequences even after treatment.
- Fertility: risks can decrease, especially with early treatment, but outcomes remain individual.
- Tumour risk: can be reduced, but often remains higher compared with the general population.
- Monitoring: becomes easier and more reliable because the testis is accessible.
For a patient-focused overview of undescended testicles and common treatments see official patient information resources. MoHFW/ICMR: Patient information on undescended testicles
Typical pitfalls that waste time
- A retractile testis is dismissed as harmless without follow-up even though the testis increasingly remains high.
- Overreliance on imaging instead of systematic examination and documentation.
- Follow-up checks are postponed too long after the first six months even though the testis still does not remain permanently in the scrotum.
- With bilateral non-palpable testes, referral to specialists is not arranged early enough.
The core 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 first days after the operation are often most important: pain management, rest and checking that the wound is healing well. Details depend on age, initial situation and surgical technique.
- Pain and rest: manageable in the first days, followed by gradual return to normal activity.
- Wound care: according to the clinic's instructions, with clear signs to seek review.
- Follow-up visits: to check position, size and development of the testis.
- Later from adolescence: sensible self-examination and early presentation for any concerns.
Costs and practical planning in India
In India diagnosis and treatment for an undescended testicle are available through both public and private providers. Government hospitals and health schemes may cover medically necessary services; private hospitals typically have separate billing. For families the organisational issues that often matter most are travel to the hospital, care for siblings and time off work.
- Plan appointments so that follow-up is feasible.
- Note questions about anaesthesia and the procedure in advance and discuss them at the consent conversation.
- Plan for sufficient rest and support at home for the first days after surgery.
For an overview of hospital services and possible patient contributions see official information pages. Overview of hospital services and charges (official information)
Legal and organisational context in India
Assessment of testicular position is part of early paediatric preventive care. In India these assessments are typically done during well-baby visits and child health clinics, and findings are recorded in health records. For medically necessary procedures parents or guardians give informed consent, and referrals and appointment coordination are usually handled through the treating paediatrician and the specialist service.
Rules on screening, cost coverage, consent and follow-up vary between countries and health systems. If you live or are treated abroad, check local standards and timeframes and bring complete records. A concise overview of child health screening can be found on official health ministry pages. MoHFW: Overview of child health screening
When to 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 stays down or if it is unclear whether it is a retractile testis.
- One or both testes are not permanently palpable in the scrotum.
- The testis appears higher, smaller or noticeably different compared with the other side over time.
- You notice that the testis is increasingly less often in the scrotum.
Immediate assessment is required for severe acute scrotal pain, sudden swelling or if the child appears very unwell. In those situations an acute scrotum must be excluded.
Conclusion
Undescended testicle is common and often initially unremarkable. For that reason it is an issue for good preventive care, clear documentation and reliable timeframes. Many cases normalise in the first months, after which early planning becomes more important.
The best approach is calm and consistent: get it examined, follow the course, refer to specialists early if descent does not occur and do not postpone necessary treatment.
