A 3-year-old recently adopted Romanian boy is referred after his initial pediatrician’s assessment for an undescended testicle. On exam his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized mass plapable at the pubic tubercle. The most appropriate next step is

**Core Concept**
Cryptorchidism, also known as undescended testicle, is a condition where one or both testicles fail to descend into the scrotum during fetal development or early childhood. This condition can be associated with an increased risk of testicular cancer, infertility, and other complications.

**Why the Correct Answer is Right**
The presence of a testicle-sized mass palpable at the pubic tubercle, combined with the empty right hemiscrotum, is highly suggestive of a retractile testicle. A retractile testicle is a common condition in young boys where the testicle can be felt to ascend into the inguinal canal and disappear from view, only to reappear when the cremaster muscle is relaxed. However, in this case, the mass is palpable at the pubic tubercle, suggesting that the testicle may be fixed in place.

The most appropriate next step is to perform a scrotal ultrasound to evaluate the position and development of the testicle. This will help to determine if the testicle is indeed fixed in place and to assess for any signs of testicular torsion or other complications.

**Why Each Wrong Option is Incorrect**
**Option A:** Immediate surgical exploration is not the most appropriate next step, as it may not be necessary if the testicle is indeed a retractile testicle.

**Option B:** A biopsy of the mass is not indicated at this time, as it may cause damage to the testicle and is not necessary for diagnosis.

**Option C:** A trial of hormonal therapy may be considered in some cases of cryptorchidism, but it is not the most appropriate next step in this case, given the presence of a palpable mass.

**Clinical Pearl / High-Yield Fact**
In children with undescended testicles, it is essential to perform a thorough examination to rule out other conditions, such as testicular torsion or hernias, which can be life-threatening if left untreated.

**Correct Answer:** C.

✓ Correct Answer: C. Right orchiopexy and right inguinal hernia repair