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Background: Cryptorchidism or undescended testis is a commonly observed congenital anomaly of male children seen in patients presenting in general and pediatric surgical practice of our region. In this study, we prospectively studied 146 cases of undescended testis to statistically observe gross and microscopic changes in different such cases. Objective: To study the gross and microscopic changes in cryptorchid testis at varied locations. Methods: A hospital-based prospective study of 146 cases of undescended testis was done from November 2014 to December 2019 and the results of gross and microscopic changes in biopsy specimens were statistically analyzed. Results: A total of 146 cases studied included 45.19% presenting at the age of 4 to 8 years and 25.34% presenting at the age of 8 to 14 years. The study revealed mild testicular atrophy in 6.16% of the cases and moderate to severe atrophy in 36.97%. Epididymal and vassal anomalies were very rare in suprascrotal testis but common in high cryptorchid testis. Biopsy specimens showed the incidence of seminomas in 4.79% of intra-abdominal testis but the incidence was lesser in undescended testis at locations lower down. Conclusion: A strong association was observed between the location of cryptorchid testis and observed gross and microscopic changes including malignant transformation.