As a parent, noticing something unusual about your child’s development can be stressful. One condition we often see in pediatric urology is undescended testicles. Knowing what this means, how it differs from normal variations, and what treatment options are available can help you feel more informed and prepared.

What Are Undescended Testicles?

Before birth, a baby boy’s testicles develop in the abdomen and usually move down (descend) into the scrotum before delivery. In some cases, one or both testicles do not move into the scrotum as expected. This is called cryptorchidism, or an undescended testicle.

It’s actually one of the most common conditions in pediatric urology, affecting about 1 in 25 full-term boys (and even more in premature boys).

Types of Testicle Position Concerns

Not every testicle that moves out of the scrotum is a cause for concern. Here are the key differences to help you understand what’s normal and what may need a closer look:

1. Retractile Testicles

• What it is: A retractile testicle has fully descended but can “move up” into the groin because of a strong cremaster muscle reflex (a normal reflex that pulls the testicle up, often when the child is cold or nervous).
• Key point: Retractile testicles can be guided down into the scrotum during an exam and usually stay there temporarily.
• Management: Most retractile testicles do not need surgery. They often permanently settle in the scrotum with age, but regular check-ups are essential to ensure they don’t become undescended over time.
• Note: Many pediatricians refer children to Pediatric Urology simply to confirm that a testicle is retractile rather than undescended. This extra check is standard and helps ensure everything is developing normally.

2. Undescended Testicles

• What it is: The testicle has not moved into the scrotum and cannot be brought down during a physical exam. It may be located in the groin or, less commonly, still inside the abdomen.
• Key point: Unlike retractile testicles, undescended testicles do not move freely down into the scrotum.
• Management: These usually require treatment, often surgical correction, before 1 year of age, to protect fertility and reduce long-term risks.

Why Treatment Matters

Leaving an undescended testicle untreated may lead to:

• Fertility issues later in life
• Increased risk of testicular cancer
• Higher chance of testicular torsion (twisting of the testicle, a painful emergency)
• Hernias in some cases

Management and Treatment Options

Observation

• In newborns, sometimes the testicle will descend on its own in the first few months of life.
• If the testicle hasn’t descended by 6 months of age, it’s unlikely to come down without treatment.

Surgery (Orchiopexy)

• The most common treatment for undescended testicles.
• Performed typically between 6–18 months of age(ideally before 1 year).
• The surgeon brings the testicle into the scrotum and secures it in place.
• This is usually an outpatient procedure, and recovery is quick.

Follow-Up Care

• Even after surgery, children require follow-up care to ensure proper testicular growth and function.
• Your pediatric urologist will also guide you on what to watch for as your child grows.

What Parents Should Do

• Attend all well-child checkups, where your pediatrician will check the position of your testicles.
• If your child is diagnosed with undescended testicles, ask for a referral to a pediatric urologist.
• Don’t wait—early treatment gives the best outcomes for fertility and overall health.

Key Takeaway for Parents

Most boys with undescended testicles do very well with timely treatment. If you have concerns, talk with your child’s healthcare provider. Early detection and management make all the difference.