Undescended Testis in children (Cryptorchidism): Causes, Treatment, and Timing

Being told that your baby’s testicle hasn’t reached its proper place can be unsettling. Will it come down on its own? Will surgery be needed? Could this affect future health?

These questions are natural. The reassuring truth is that undescended testis is common, well understood, and highly treatable when managed at the right time.

Understanding Undescended Testis

During fetal development, the testis forms inside the abdomen and gradually travels down into the scrotum before birth.
Around 3% of newborn boys are born with a testis that has not completed this journey.

Most testes descend naturally within the first 6 months
A smaller number descend between 6 and 12 months
After one year of age, only about 1% remain undescended

When one or both testes are still not in the scrotum beyond the expected age, the condition is called undescended testis.

Not All “High” Testes Are the Same

In some children, the testis may move up and down — appearing in the scrotum at times and retreating into the groin at others. This is called a retractile (shy) testis.

A retractile testis is not the same as a true undescended testis
It usually requires observation and follow-up, not immediate surgery

A true undescended testis, however, does not stay in the scrotum and needs medical attention.

Where Could the Testis Be Located?

When a testis cannot be felt in the scrotum, Several possibilities exist:

Stopped partway in the groin (True undescended testis)
Positioned outside the normal pathway (Ectopic testis)
Located inside the abdomen (Intra-abdominal testis)
Poorly developed or shrunken (Atrophic testis)
Rarely, absent due to loss of blood supply before birth (Vanishing testis)

Each of these conditions has distinct implications, making expert clinical evaluation essential..

How Is Undescended Testis Diagnosed?

In most children, a careful clinical examination by a pediatric urologist is sufficient.

About 20% of testes are non-palpable, meaning they cannot be felt during examination.

In these cases:

Ultrasound or MRI usually does not provide reliable answers
Laparoscopy is the most accurate method for diagnosis and treatment

Laparoscopy uses a tiny camera inserted through the belly button to precisely locate the testis inside the abdomen.

Why Does Early Treatment Matter So Much?

An undescended testis left untreated can increase the risk of:

Reduced fertility in adulthood
Higher chance of Testicular Cancer
Increased risk of Testicular Torsion
Psychological and cosmetic concerns due to an empty scrotum

The good news?
Early treatment dramatically reduces these risks and protects long-term testicular function.

When Should Surgery Be Done?

The ideal age for surgical correction is between 6 and 12 months. If the child also has an inguinal hernia, surgery should be performed earlier, without waiting.

The Gold-Standard Treatment

The definitive treatment for undescended testis is orchiopexy.

During the procedure:

A small incision is made in the groin
The testis is gently freed from surrounding tissues
Any associated hernia sac is repaired
The testis is placed securely in the scrotum and fixed in position

This also helps prevent future torsion.

Hormonal therapy may be tried in select situations, but its success rate in true undescended testis is low. Surgery performed by an experienced pediatric urologist remains the most effective and definitive treatment.