Undescended Testis in Children: Why Early Evaluation Matters?

Let us understand absent testes or an empty scrotum in children, the importance of timely evaluation, and when surgery may be needed.

Many parents notice it during bathing or diaper changes—a child appears to have an empty scrotum or one side of the scrotum seems smaller than the other. While this may sometimes be temporary, in certain children it may indicate an undescended testis, a condition that should not be ignored.

An undescended testis occurs when one or both testes fail to move down into the scrotum before birth. Parents may describe this in simpler terms as an “absent testis” or “empty scrotum.” It is one of the most common conditions seen in newborn boys, especially in premature babies.

In some infants, the testis may descend naturally during the first few months of life. Because of this, careful observation is sometimes appropriate initially. However, if the testis remains undescended beyond the expected period of spontaneous descent, evaluation by a pediatric surgeon or pediatric urologist becomes important.

Parents may notice:

• One side of the scrotum appearing empty
• Unequal scrotal size
• Absence of a visible testis during bathing or diaper changes
• Occasionally, a testis that seems to “move up” and disappear

The role of a pediatric surgeon is not only to confirm whether the testis is truly undescended, but also to differentiate it from conditions such as a retractile testis, where surgery may not be immediately necessary.

The best approach depends on the child’s age and examination findings. In many children, surgery called orchidopexy is recommended if the testis does not descend naturally within the first few months of life. Early surgery helps place the testis in the scrotum and allows proper monitoring and development.

Delayed treatment can increase the risk of complications including:

• Reduced fertility potential later in life
• Higher risk of testicular torsion
• Associated inguinal hernia
• Increased long-term risk of testicular malignancy
• Psychological concerns related to an empty scrotum

A pediatric surgeon frequently evaluates children with undescended testes and guides parents regarding whether observation or surgery is appropriate. The decision is individualized and based on factors such as the child’s age, the position of the testis, and whether spontaneous descent is still likely.

Early recognition and timely referral are important because an undescended testis is not simply a cosmetic issue—it is a condition where proper pediatric surgical evaluation can help prevent future complications and improve long-term outcomes.

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Dr Aditya J Baindur
Pediatric Surgeon & Pediatric Urologist
Bangalore