In a 3‑year‑old child with unilateral undescended testis and absent scrotum on that side, which of the following is most commonly associated: hypospadias, inguinal hernia, pyloric stenosis, or congenital heart disease?

Inguinal Hernia is the Most Common Associated Condition

In a 3-year-old with unilateral undescended testis and absent scrotum on the affected side, inguinal hernia (Option B) is the correct answer and the most commonly associated condition. 1, 2

Why Inguinal Hernia is the Primary Association

The embryologic connection between testicular descent and inguinal hernia formation is direct and well-established:

• Between 25-35 weeks gestation, the testis descends through the inguinal canal, drawing with it an extension of the peritoneal lining called the processus vaginalis. 3, 2

• Incomplete involution of the processus vaginalis creates a patent processus vaginalis (PPV), through which intra-abdominal structures can herniate, forming an indirect inguinal hernia. 3, 2

• More than 90% of pediatric inguinal hernias occur in boys specifically because of this relationship between the processus vaginalis and testicular descent. 3, 2

• The American Urological Association explicitly identifies inguinal hernia as one of the main reasons for treatment of cryptorchidism, alongside fertility concerns, testicular malignancy risk, and torsion. 1, 4

• PPV prevalence is as high as 80% in term male infants, though not all progress to clinically apparent hernias. 2

Why the Other Options Are Incorrect

Hypospadias (Option A)

• Hypospadias can co-exist with cryptorchidism as part of testicular dysgenesis syndrome, but this association is less common than inguinal hernia. 2
• When cryptorchidism presents with hypospadias or other phallic anomalies, this combination should prompt evaluation for disorders of sex development rather than being considered a routine association. 1, 2
• Hypospadias represents aberrant androgen signaling, a different pathophysiologic mechanism than the mechanical PPV issue causing hernias. 1

Pyloric Stenosis (Option C)

• Pyloric stenosis has not been shown to be associated with cryptorchidism; the two conditions arise from distinct embryologic pathways. 1
• There is no shared embryologic or pathophysiologic mechanism linking these conditions.

Congenital Heart Disease (Option D)

• There is no evidence linking isolated cryptorchidism with congenital heart defects according to American Urological Association guidelines. 1
• Congenital heart disease is not mentioned as an associated condition in any major cryptorchidism guidelines. 1, 4

Clinical Management Implications

• All infant inguinal hernias should be surgically repaired to avoid bowel incarceration and gonadal infarction; the standard approach is concurrent repair at the time of orchiopexy, ideally before 18 months of age. 1

• Examine for inguinal bulge or hernia during physical examination of any boy with cryptorchidism. 1

• Referral to a surgical specialist by 6 months of age (corrected for gestational age) is recommended if spontaneous descent has not occurred. 2, 4