Hypospadius is the most common congenital penile abnormality. The urethral meatus opens abnormally on the ventral surface of the penis. One form is shown above; more severe forms involve openings on the lower shaft or scrotum.
You should distinguish between undescended testes, shown above (with testes in the inguinal canals), from highly retractile testes due to an active cremasteric reflex.
In school-age and adolescent boys, two types of torsion can occur: torsion of the testis and torsion of the appendix testis. In torsion of the testis, boys have acute severe testicular pain. Examination shows a swollen, tender testis and an absent cremasteric reflex. In torsion of the appendix testis (not shown), there is also acute pain, although generally not as sever as with torsion of the testis. You may note a bluish discoloration (blue dot sign) at the iniàrcted appendage. In these cases, the cremasteric reflex is usually present
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