Purpose 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. Methodology A prospective cohort study of children referred to the Queensland Children’s Hospital for anomalies of testicular descent between 2015-17 and 2023-24. Data were collected regarding demographics, referral details, imaging performed, and surgical diagnosis. Results 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.80% 2015-17, 63.64% 2023-24). Currently, 17.58% of families are charged, and 31.87% need to take time off work, for the ultrasound. This is a significant increase from the 2015-17 cohort. Parents report concern and anxiety, and find it traumatic for their child. The majority (65.73%) have physiologically normal testes, while 4.90% and 23.08% were diagnosed with bilateral or unilateral cryptorchidism respectively, and 6.29% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.00% (2015-17) and 30.69% (2023-24). Ultrasound did not contribute to diagnosis or management in any patient. Conclusion Despite numerous international clinical guidelines, most children seen in our clinic for disorders of testicular descent continue to undergo ultrasound prior to referral, and this has not significantly reduced over time. We have shown such ultrasounds do not provide utility, and in an era of value-based care, do not provide value for cost. We recommend avoiding their routine use for presumptive disorders of testicular descent.