Undescended Testis in Children: When Should It Be Treated?
A parent-friendly guide to cryptorchidism, timing of assessment, and when surgery may be recommended.
Undescended Testis: Key Points for Parents
- An undescended testis means one or both testes are not in the scrotum.
- Some testes descend naturally in early infancy.
- If it remains undescended after 3–6 months, specialist assessment is usually advised.
- Surgery, called orchiopexy, may be recommended to place the testis in the scrotum.
- Follow-up helps monitor testicular position and development.
What Is an Undescended Testis?
An undescended testis, also called cryptorchidism, occurs when one or both testes are not located in the scrotum.
During pregnancy, the testes usually develop inside the abdomen and move down into the scrotum before birth. In some boys, this descent is delayed or incomplete.
An undescended testis may be found:
- in the groin
- higher up in the abdomen
- not easily felt during examination
Sometimes, the testis may move up and down between the groin and scrotum. This is known as a retractile testis, which is different from a true undescended testis and may not require surgery.
How Common Is Undescended Testis?
Undescended testis is one of the more common genital conditions seen in baby boys. It is more common in premature babies.
In some babies, the testis may descend naturally during the first few months of life. However, if it remains undescended after this period, further assessment is usually recommended.
Can It Come Down on Its Own?
In some babies, an undescended testis may come down naturally within the first few months after birth.
However, if the testis has not descended by around 6 months of age, it is less likely to come down on its own.
This is why ongoing review is important. Parents should not feel rushed, but persistent undescended testis should not be ignored.
When Should a Child Be Assessed?
A child should be assessed if:
- one or both testes are not seen or felt in the scrotum
- the scrotum looks underdeveloped or uneven
- the testis was previously in the scrotum but now seems higher
- there is a swelling in the groin
- there is pain, redness, or sudden swelling in the groin or scrotum
If there is sudden pain or swelling, urgent medical attention is needed.
How Is Undescended Testis Diagnosed?
Diagnosis is usually made by clinical examination.
The doctor will examine the groin and scrotum to determine whether the testis is:
- normally descended
- retractile
- undescended but palpable
- not palpable
In many cases, ultrasound is not necessary before referral, especially if the testis can be assessed clinically. Further investigations may be considered if the testis cannot be felt or if both testes are absent from the scrotum.
When Is Surgery Usually Recommended?
If the testis remains undescended after early infancy, surgery is commonly recommended around 12 months, depending on the child’s condition and specialist assessment.
The aim is to place the testis in the scrotum at an age that supports better testicular development and easier long-term monitoring.
For older children, assessment is still important, especially if the testis appears to have moved back up after previously being in the scrotum.
What Is Orchiopexy?
Orchiopexy is the operation used to bring an undescended testis down into the scrotum and secure it in place.
The exact approach depends on where the testis is located.
If the testis is felt in the groin, surgery may involve small incisions in the groin and scrotum.
If the testis is higher up or cannot be felt, keyhole assessment may sometimes be needed to locate it and plan treatment.
In some cases, surgery may need to be done in stages.
Recovery After Orchiopexy
Many children recover well after orchiopexy.
After surgery, parents are usually advised about:
- wound care
- pain relief
- bathing
- activity restriction
- follow-up appointments
The child will usually be reviewed to check that the testis remains in the scrotum and is developing appropriately.
Long-Term Follow-Up
Follow-up is important after treatment.
As the child grows, doctors may monitor:
- testicular position
- testicular size
- healing after surgery
- any concerns with the opposite testis
When the child is older, he should also be taught testicular self-awareness in an age-appropriate way.
Paediatric Urology Assessment in Kuala Lumpur
Undescended testis is a common condition, but timing of assessment and treatment is important.
A paediatric urology assessment can help confirm whether the testis is truly undescended, retractile, or has ascended later in childhood. The treatment plan should be individualised based on the child’s age, examination findings, testis position, and overall health.
Parents who are concerned that one or both testes are not in the scrotum should seek medical assessment for proper diagnosis and guidance.
Concerned About an Undescended Testis?
If your child’s testis is not consistently seen or felt in the scrotum, a paediatric urology assessment can help clarify whether monitoring or treatment may be needed.
Appointments with Dr Roger Anthony Idi are arranged through Prince Court Medical Centre.