Undescended Testis in Children: A Complete Parent Guide

By Dr. Dhruv Mahajan, Pediatric Surgeon & Pediatric Urologist

One of the most common concerns parents bring to my clinic is:

"Doctor, one of my baby's testicles is missing."

Or sometimes they say,

"The doctor told us that one testis has not come down. Should we wait?"

If your child has been diagnosed with an undescended testis (Undescended Testicle / Cryptorchidism), don't panic. It is a common condition in newborn boys, and in most cases it can be treated successfully with a simple surgery performed at the right age.

As a Pediatric Surgeon and Pediatric Urologist, I regularly treat children with this condition and would like to explain everything parents need to know in simple language.

What is an Undescended Testis?

A baby boy normally has two testicles (testes). During pregnancy, these testicles develop inside the abdomen and gradually move down into the scrotum before birth.

When one or both testicles fail to reach the scrotum, the condition is called an Undescended Testis (Cryptorchidism).

It may affect:

• Only the right side

• Only the left side

• Both sides (less common)

Parents usually notice that one side of the scrotum looks empty or smaller than the other.

How Common is Undescended Testis?

Undescended testis is one of the most common birth conditions seen in boys.

It occurs in approximately:

• 3–5% of full-term newborn boys

• Up to 30% of premature babies

The good news is that many testicles descend naturally during the first few months after birth.

However, if the testis has not come down by 6 months of age, it is very unlikely to descend on its own.

Why Does It Happen?

In most children, there is no fault of the parents and no specific reason can be identified.

Possible factors include:

• Premature birth

• Low birth weight

• Family history

• Hormonal influences during pregnancy

• Genetic factors

Most cases happen randomly.

Signs Parents May Notice

Many babies with undescended testis have no pain.

Parents may notice:

• Empty scrotum

• One side of the scrotum looks smaller

• Only one testicle can be felt

• Pediatrician mentions it during routine newborn examination

Sometimes the testis can be felt in the groin.

Sometimes it cannot be felt at all.

Can the Testis Come Down on Its Own?

Yes—but only during early infancy.

Most spontaneous descent occurs before 6 months of age.

After that, waiting usually does not help.

That is why international pediatric surgery guidelines recommend treatment at the appropriate time rather than delaying for years.

Why Should Undescended Testis Be Treated?

Many parents ask:

"If my child is not having any problem, why is surgery needed?"

This is an excellent question.

Leaving an undescended testis untreated can increase the risk of:

1. Reduced Fertility

The temperature inside the abdomen is higher than inside the scrotum.

Over time, this higher temperature can affect sperm-producing cells.

Early treatment helps protect future fertility.

2. Testicular Cancer

An undescended testis has a higher lifetime risk of developing testicular cancer compared to a normally descended testis.

Bringing the testis into the scrotum makes examination and future monitoring much easier.

3. Testicular Torsion

The undescended testis can twist on itself (torsion), cutting off its blood supply.

This is a surgical emergency.

4. Inguinal Hernia

Many children with undescended testis also have an associated hernia that can be corrected during the same surgery.

5. Psychological Concerns

As children grow older, differences in the appearance of the scrotum may affect self-confidence and body image.

At What Age Should Surgery Be Done?

This is one of the most important questions.

Current recommendations suggest surgery between:

6 and 12 months of age, and ideally before 18 months if the testis has not descended naturally.

Early surgery offers the best chance of preserving normal testicular function.

Does My Child Need an Ultrasound?

Many parents are surprised when I tell them:

In most cases, ultrasound is NOT necessary before seeing a pediatric surgeon.

If the testis cannot be felt during examination, an ultrasound often does not change the treatment plan.

A careful physical examination by an experienced pediatric surgeon is usually much more valuable.

Sometimes additional investigations are required, but they are decided on an individual basis.

How is Undescended Testis Diagnosed?

Diagnosis is mainly through:

• Detailed history

• Physical examination

• Examination while the child is relaxed

Occasionally, laparoscopy may be required if the testis cannot be located.

What is Orchidopexy?

The surgery performed to treat an undescended testis is called Orchidopexy.

During the operation:

• The testis is gently freed from surrounding tissues.

• It is brought down into the scrotum.

• It is fixed securely in its normal position.

If the testis is inside the abdomen, a laparoscopic (keyhole) surgery may be required.

Is Orchidopexy Safe?

Yes.

Orchidopexy is a commonly performed pediatric surgical procedure with excellent success rates when performed by an experienced pediatric surgeon.

The operation is done under general anesthesia, and children usually recover quickly.

Most children are discharged the same day or the next day, depending on the individual case.

Recovery After Surgery

Most children:

• Start walking within a day

• Resume light activity quickly

• Need only mild pain medicines

• Return to normal routine within a few days

Parents receive detailed wound-care instructions before discharge.

What Happens if the Testis Cannot Be Saved?

In a small number of children, the testis may be very poorly developed or non-functional.

In such situations, your pediatric surgeon will explain the best management option after assessing the condition during surgery.

Fortunately, the other healthy testis is usually sufficient for normal hormone production and future fertility.

Frequently Asked Questions

Can massage bring the testis down?

No.

Massage does not help.

Can medicines treat undescended testis?

Hormonal injections have a limited role and are generally not recommended as routine treatment.

Surgery remains the standard treatment.

Will my child become infertile?

Not necessarily.

Early diagnosis and timely surgery significantly improve the chances of preserving fertility.

Is the surgery painful?

Children usually experience only mild discomfort that is well controlled with medicines.

Can the problem come back?

Recurrence after successful orchidopexy is uncommon but follow-up visits are important.

When Should You Consult a Pediatric Surgeon?

Please seek evaluation if:

• One testicle is missing after 6 months of age

• The scrotum appears empty

• Testis disappears repeatedly into the groin

• You are unsure whether both testicles are present

• Your family doctor has advised further evaluation

Early consultation helps ensure timely treatment and the best possible outcome.

Final Thoughts

Undescended testis is a common condition, but timing matters.

The earlier it is diagnosed and treated, the better the chances of protecting your child's future fertility, reducing complications, and ensuring normal development.

If you notice an empty scrotum or have been told that your baby has an undescended testis, don't ignore it or wait for several years hoping it will correct itself. A consultation with a pediatric surgeon can provide clarity and guide you toward the right treatment at the right time.

About the Author

Dr. Dhruv Mahajan is a Pediatric Surgeon and Pediatric Urologist with expertise in minimally invasive (laparoscopic) surgery for infants and children. He manages conditions such as undescended testis, hydrocele, inguinal hernia, hypospadias, phimosis, pediatric kidney and urinary problems, neonatal surgical conditions, and other congenital anomalies.

He consults and performs pediatric surgical procedures for children from Ambala, Chandigarh, Patiala, Kurukshetra, Karnal, Yamunanagar, Panchkula, Mohali, Zirakpur, Rajpura, Kaithal, and nearby regions, providing specialized surgical care closer to home.

If you are concerned about an undescended testis in your child, early evaluation can make a significant difference in long-term outcomes.