What does undescended testicle mean?
In undescended testicle, medically maldescensus testis or cryptorchidism, one or both testicles are not permanently in the scrotum. Often the testicle is located in the inguinal canal, less commonly in the abdomen. The key point is that the testicle does not reliably remain down in the scrotum.
Different from this is a retractile testicle. In that case a normally developed testicle is temporarily pulled upward by a strong muscle reflex, but it can be brought into the scrotum and stays there at least temporarily. This should also be assessed by a physician 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 much more frequently in preterm infants than in full-term babies. In the first months of life the testicle can still descend spontaneously, which is why close follow-up is common during this period.
- Follow-up is especially 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 hoping for late spontaneous descent.
A professional guideline overview is available in the guideline registry. AWMF: S2k guideline Undescended Testis
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 over time 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 testicle is associated with an increased risk of later problems. These include impaired fertility and a higher risk of testicular tumors. Early treatment can reduce risks but does not replace follow-up.
- Unilateral undescended testicle can affect future fertility, often less so than bilateral cases.
- Bilateral undescended testicles are generally more relevant to future fertility concerns.
- Follow-up remains important even after early treatment.
Causes and risk factors
Why a testicle does not fully descend can have several causes. Often it is a combination of anatomical and hormonal factors. For parents it is especially important to know: this is rarely caused by behavior during pregnancy and is generally not affected by infant 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 doesn't
In the first months of life waiting is often reasonable because spontaneous descent is still possible. If the testicle has not reached the scrotum after that, the likelihood it will normalize without treatment decreases.
- Early months: monitoring the course is the priority.
- If the testicle is not permanently in the scrotum: plan specialist evaluation early.
- Many guidelines recommend surgical correction during the first year of life, no later than about 18 months of age.
The European guideline perspective summarizes the approach in a structured way. EAU: Pediatric Urology guideline chapter
How evaluation typically proceeds
The most important basis is the physical examination. The clinician checks whether the testicle is palpable, how high it is, and whether it can be brought into the scrotum. This often already indicates whether it is more likely a retractile testicle, an ascending testicle, or a true undescended testicle.
- Is the testicle palpable or nonpalpable?
- 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 helpful in some situations but does not replace the examination. If a testicle is nonpalpable, further diagnostics in pediatric 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 testicle in the scrotum, orchidopexy. The testicle is brought into the correct position and secured so it remains there. An inguinal hernia or a patent processus vaginalis is often checked and treated at the same time.
- For a palpable testicle in the inguinal area: orchidopexy via a small incision.
- For a nonpalpable testicle: diagnostic and therapeutic laparoscopy is often used.
- For a very high testicle: staged procedures may be considered in individual cases.
Individual planning by experienced pediatric urology or pediatric surgery teams is crucial.
What about hormone treatment?
Hormonal therapies are sometimes discussed to stimulate testicular descent. Their benefit is limited in many situations and is assessed differently across guidelines. In many cases surgical correction is preferred because it more reliably places the testicle in the scrotum.
- If hormones are considered, this should occur in specialized care.
- More important than the method is that no critical time window is missed.
Realistic expectations: what early treatment improves
Early correction improves the conditions for normal tissue development. It also makes later examinations easier because the testicle is more readily palpable in the scrotum. This matters because even after treatment an increased risk for certain long-term effects can remain.
- Fertility: risks can be reduced, especially with early treatment, but outcomes are individual.
- Tumor risk: can be reduced, but often remains elevated compared with the general population.
- Examination: is easier and more reliable because the testicle is easily accessible.
A patient-focused overview of undescended testicles and common treatments is also available from the NHS. NHS: Undescended testicles
Common pitfalls that waste valuable time
- A retractile testicle is dismissed as harmless without follow-up, even though the testicle may increasingly remain high.
- Relying on imaging instead of consistently performing examination and documentation.
- Delaying follow-up after the first six months even though the testicle still does not remain permanently in the scrotum.
- Not referring early enough to specialists when both testicles are nonpalpable.
The core logic is simple: the early months allow for spontaneous normalization, after that reliable planning becomes more important.
Follow-up and safety around the operation
An orchidopexy is generally performed under general anesthesia. For parents the first days after surgery are usually decisive: 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, with gradual return to normal activity afterward.
- Wound care: follow the hospital's instructions, with clear warning signs for reassessment.
- Follow-up visits: to check position, size, and development of the testicle.
- Later from adolescence: sensible self-examination and prompt presentation for any concerns.
Costs and practical planning in the US
In the United States coverage for evaluation and treatment of an undescended testicle varies by insurance. Medically necessary services are typically covered by health plans, but families often find logistics such as travel, care for siblings, and time off work to be the main practical concerns.
- Schedule appointments so follow-up care is feasible.
- Write down questions about anesthesia and the procedure to discuss during the informed-consent meeting.
- Plan for sufficient rest and support during the first days after surgery.
For general information on hospital services and potential out-of-pocket costs, check your insurer or local official resources. Overview of general hospital services and co-pays
Legal and organizational context in the US
Assessment of testicle position is part of routine pediatric preventive care. In the US these checks are performed during well-child visits and documented in the child's medical record. For medically indicated procedures parents or guardians provide informed consent, and referrals and scheduling are typically coordinated through primary pediatric care to specialists.
Regulations on screening, coverage, consent, and follow-up differ internationally and between insurers. If you live or plan to have treatment abroad, ask about local standards and timelines and take full documentation with you. For a concise overview of preventive child health checks, consult national pediatric guidance or your healthcare provider. Overview of preventive child health checks
When you should seek medical advice
If a testicle in an infant or toddler is not palpable in the scrotum, it should be checked by a pediatrician in a timely manner even if the child has no symptoms. The same applies if the testicle no longer reliably remains down or if it is unclear whether it is retractile.
- One or both testicles are not consistently palpable in the scrotum.
- The testicle appears higher, smaller, or noticeably different from the opposite side over time.
- You notice the testicle 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 ill. In those cases an acute scrotum must be ruled out urgently.
Conclusion
Undescended testicle is common and often unremarkable at first. Precisely for that reason it is a topic for good preventive care, clear documentation, and reliable timelines. Many cases normalize in the first months, but after that early planning is more important.
The best strategy is calm and consistent: get it examined, monitor the course, refer to specialists early if descent does not occur, and do not postpone treatment unnecessarily.
