Due to its noninvasiveness and high resolving power, ultrasound examination is the examination of choice for the imaging of the structures of the pediatric scrotum. It allows to reveal changes impossible to find in the course of a clinical examination. Its significance has increased over the past few years due to the technological developments. The introduction of transducers with frequency of 10–17 MHz has improved the resolution of pediatric testes images as well as the resolution of the inguinal canals images, which has been of particular importance for the evaluation of undescended, retractile and abdominal testes. New diagnostic tools have also been introduced, such as 3D imaging or elastography, whose application has helped provide valuable additional information for the evaluation of pediatric testes, for treatment monitoring, and for post-surgical follow-up examinations. 3D imaging facilitates a more accurate evaluation of the location of an undescended testicle, testicular volume, and vascularization. Elastography may be used for the evaluation of focal lesions, post-ischemic lesions, unclear fluid spaces, undescended testes, and following orchiopexy.