Inguinal Hernia is the Associated Finding
In a 3-year-old with unilateral undescended testis and absent scrotum on the affected side, inguinal hernia (Option B) is the most likely associated condition. 1, 2, 3
Embryological Basis for the Association
The strong association between cryptorchidism and inguinal hernia stems from a shared embryological mechanism:
- Both conditions result from incomplete involution of the processus vaginalis during testicular descent between 25-35 weeks of gestation. 3
- When the processus vaginalis remains patent, it simultaneously creates the pathway for inguinal hernia formation and is associated with arrested testicular descent. 3
- More than 90% of pediatric inguinal hernias occur in boys, directly reflecting this relationship with testicular descent abnormalities. 3
Clinical Guideline Evidence
The American Urological Association explicitly identifies inguinal hernia as one of the main reasons for treatment of cryptorchidism, alongside increased risks of impaired fertility, testicular malignancy, and torsion. 1, 2
During physical examination of any boy with cryptorchidism, you must examine for inguinal bulge or hernia. 2
Why the Other Options Are Incorrect
Hypospadias (Option A)
- While hypospadias can co-exist with cryptorchidism, the presence of both anomalies together should prompt consideration of disorders of sex development rather than being a simple associated finding. 2
- This combination suggests aberrant androgen signaling or potential intersex conditions requiring additional endocrine evaluation. 2
Pyloric Stenosis (Option C)
- Pyloric stenosis has not been shown to be associated with cryptorchidism; the two conditions arise from distinct embryologic pathways. 2
Congenital Heart Disease (Option D)
- There is no evidence linking isolated cryptorchidism with congenital heart defects according to the American Urological Association guidelines. 2
Critical Clinical Caveat
In this specific case with absent scrotum on the affected side plus undescended testis, you must evaluate for disorders of sex development, including the possibility of life-threatening congenital adrenal hyperplasia in a genetic female. 2 The combination of multiple genital anomalies (cryptorchidism + absent scrotum) is not simple isolated cryptorchidism and warrants immediate specialist consultation.
Management Implications
All inguinal hernias in infants require surgical repair to prevent bowel incarceration and gonadal infarction, making concurrent repair during orchiopexy the standard approach. 3 This child needs referral to pediatric urology or pediatric surgery for combined orchiopexy and hernia repair, ideally before 18 months of age. 1