Aim Evidence-based guidelines do not recommend imaging in cryptorchidism, but anecdotally most referrals include an ultrasound report. We aimed to assess the frequency, utility and burden of imaging in children referred with presumptive disorders of testicular descent, and to assess trends over a 7-year period before and after local and international guidelines have been introduced.

Methods This was a prospective cohort study of children referred to the Queensland Children's Hospital for anomalies of testicular descent between 2015–2017 and 2023–2024. Data were collected regarding demographics, referral details, imaging performed and surgical diagnosis.

Results A total of 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.8%, 2015–2017; 63.6% 2023–2024; P = 0.11). Currently, 17.6% of families are charged, and 31.9% need to take time off work, for the ultrasound. This is a significant increase from the 2015–2017 cohort. Parents report concern and anxiety, and find it traumatic for their child. Following review, the majority (65.7%) had physiologically normal testes, while 4.9% and 22.4% were diagnosed with bilateral or unilateral cryptorchidism, respectively, and 7.0% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.0% (2015–2017) and 30.7% (2023–2024). Ultrasound did not contribute to diagnosis nor management in any patient.

Conclusions Despite international and local guidelines, cryptorchid children continue to undergo ultrasound prior to referral. Such ultrasounds do not provide utility, or value for cost. We recommend avoiding their routine use for suspicion of testicular maldescent and working together to improve strategies for translating evidence-based guidelines into clinical practice.