Hypospadias

Hypospadias, in which the urethra opens on the underside of the penis, is infrequently seen (Fig. 40-9). However, it is important that hypospadias is recognized early, preferably at the initial newborn examination. It can occur with or

Table 40-4 Selected Differential Diagnosis of Scrotal Masses with Physical Findings

Abnormality

Physical Finding

Epididymitis, orchitis

Tender mass

Hydrocele

Transilluminates

Inguinal hernia

Does not transilluminate

Testicular torsion

Pain and loss of cremasteric reflex

Torsion of the appendix testis

Blue dot sign

Trauma

Tender scrotum, edema, trauma history

Tumor

Solid mass

Spermatocele

Nontender cystic mass

Varicocele

Bag of worms appearance

Figure 40-9 Hypospadias. (From Borer JG, RetikAB. Hypospadias. In Wein AJ[ed]. Campbell-Walsh Urology, 9th ed, vol IV, Philadelphia, Elsevier, 2007.)

without chordee (curvature). Circumcision should be withheld and a urology consultation obtained. Hypospadias must be differentiated from ambiguous genitalia, which implies an intersex disorder. Epispadias, in which the meatus is located on the dorsal surface of the penis, is uncommon and is usually associated with extrophy of the bladder.

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