Undescended Testicle

An undescended testicle is a testis that does not move down into the scrotum before birth or during the early postnatal period, where it is normally expected to be found. Some cases correct spontaneously during the first months of life, but if the condition persists, timely urologic assessment and, in many cases, surgical correction are important. ^[1][2][3]

What kind of condition is an undescended testicle?

An undescended testicle occurs when the testis does not complete its normal descent from the abdomen into the scrotum. The medical term is cryptorchidism. It most often affects one side, but both testicles may be involved. It is especially common at birth in premature infants. The condition usually does not cause pain; the main finding is that one or both testicles cannot be felt in the scrotum, or one side of the scrotum appears emptier than expected. ^[1][2][3]

This condition is different from a retractile testis. In a retractile testis, the testicle may occasionally be pulled upward, but it can usually be guided into the scrotum during examination and often settles there normally by puberty. In true undescended testis, the testicle does not remain in the scrotum. This distinction matters because monitoring and treatment are different in true cryptorchidism. ^[1][2][4]

Symptoms and findings parents may notice

The most obvious sign is that the testicle is not seen or felt in the scrotum. Parents may notice that one side appears empty during bathing or diaper changes. Most babies do not have pain, redness, or general illness. For that reason, the condition is often detected during routine pediatric examinations or through careful observation at home. ^[1][2]

If abdominal swelling, sudden groin pain, or unusual irritability is present, testicular torsion or another urgent problem should be considered. In some cases, the testicle can be felt in the groin canal; in others, it cannot be felt at all. A nonpalpable testis may be located in the abdomen, or a different developmental condition may be present. Physical examination is therefore highly important, and self-diagnosis is not appropriate. ^[1][2][3]

What causes it, and who is at greater risk?

The cause of undescended testis cannot always be explained by a single factor. Hormonal signals, the mechanical descent pathway, and genetic influences all appear to play a role during fetal development. Prematurity, low birth weight, and some developmental conditions increase risk, although the problem can also occur in healthy full-term infants. ^[1][2][4]

Parents often ask whether diaper use or something done after birth caused the problem. Current evidence suggests that the condition is usually related to prenatal developmental processes. Families should therefore not blame themselves. What matters is that, once recognized, the child is evaluated at the right time by a pediatrician or pediatric urologist. ^[1][2][3]

How is the diagnosis made?

Diagnosis is based primarily on physical examination. The clinician assesses whether the testicle is in the scrotum, whether it can be felt in the groin canal, and how the finding differs from a retractile testis. In many cases, examination alone is sufficient. Imaging is not always the first step, because ultrasonography is not consistently definitive, especially when the testis is nonpalpable. Expert surgical planning is often more important than routine imaging. ^[1][2]

Once the diagnosis is made, the critical issue is appropriate timing. Some testicles descend spontaneously during the first months after birth. If descent has not occurred after an appropriate observation period, the condition is considered persistent and referral is indicated. Situations such as bilateral nonpalpable testes may require more detailed hormonal and developmental evaluation. ^[1][2][4]

Treatment and timing of surgery

Current sources recommend not delaying treatment if spontaneous descent does not occur. Mayo Clinic notes that planning treatment within the first year of life may reduce future risks and that surgery is often considered before 18 months of age. The standard approach is usually orchiopexy, a procedure that places the testicle in the scrotum. ^[1][3]

Although hormonal treatment is discussed in limited circumstances in some centers, surgery is the main treatment in many patients. The goal is not merely cosmetic. Timely correction makes examination easier, supports testicular development, and helps reduce long-term risk. Ongoing follow-up is also important after surgery so that testicular size, position, and later complications can be monitored. ^[1][2][3]

Why is it important: infertility and cancer risk

Timely treatment matters because a testicle that remains in the abdomen or groin for too long is exposed to a warmer environment than normal, which may affect future sperm production. The risk of testicular cancer is also higher than in a normally descended testis. Surgery does not eliminate this risk completely, but it improves examination and long-term surveillance. ^[1][2][3]

Many children with one-sided disease can go on to live normal lives, but the risks should not be dismissed. In bilateral undescended testes, the effect on fertility potential may be more pronounced. For that reason, families should avoid the mindset of “the child is still young, we will deal with it later.” Correct timing is one of the most important factors influencing long-term outcomes. ^[1][2][4]

When is urgent or early evaluation needed?

The absence of a testicle from the scrotum alone is not an emergency. However, sudden groin pain, vomiting, irritability, a tender groin swelling, or color change in the scrotum requires urgent evaluation because conditions such as torsion can compromise blood supply and damage testicular tissue. Bilateral nonpalpable testes or associated differences in genital development should also be evaluated without delay. ^[1][2]

It is equally important not to miss routine follow-up after birth. Because the condition is often painless, it can easily be overlooked. Timely detection during pediatric examination helps prevent unnecessary delay. Although follow-up and surgical planning vary according to the individual child, the aim is to achieve a durable solution at the appropriate stage of development. ^[1][2][3]

Why is postoperative follow-up important?

After surgery, follow-up is used to confirm that the testicle remains in the scrotum, to monitor how its size develops, and to assess the opposite testicle as well. As the child grows, educating the family—and later the adolescent—about awareness of testicular health is useful for long-term monitoring. Even after successful surgery, it is not appropriate to abandon follow-up completely, because the goal is not only to bring the testicle down but also to protect long-term testicular health. ^[1][2][3]

Persistent, worsening, or alarm-type symptoms require individualized medical evaluation; this text does not replace a diagnosis. ^[1][2]