Inspect the male genitalia with the infant in the supine position, noting the appearance of the penis, testes, and scrotum. The foreskin completely covers the glans penis. It is nonretractable at birth, though you may be able to retract it enough to visualize the external urethral meatus. Retraction of the foreskin in the uncircumcised male occurs months to years later. The rate of circumcision has declined recently in North America and varies worldwide, depending on cultural practices.
Inspect the shaft of the penis, noting any abnormalities on the ventral surface. Make sure the penis appears straight.
Scrotal edema may be present for several days following delivery due to the effect of maternal estrogens.
Inspect the scrotum, noting rugae, which should be present by 40 weeks' gestation. Palpate the testes in the scrotal sacs, proceeding downward from the external inguinal ring to the scrotum. If you feel a testis up in the inguinal canal, gently milk it downward into the scrotum. The newborn's testes should be about 10 mm in width and 15 mm in length and should lie in the scrotal sacs most of the time.
In 3% of neonates, one or both testes cannot be felt in the scrotum or inguinal canal. This raises concern of cryptorchidism. In two thirds of these cases, both testes are descended by 1 year of age.
Examine the testes for swelling within the scrotal sac and over the inguinal ring. If you detect swelling in the scrotal sac, try to differentiate it from the testis. Note whether the size changes when the infant increases abdominal
Splenomegaly can be caused by a variety of diseases, including infections, hematologic disorders such as hemolytic anemias, infiltrative disorders, and inflammatory or autoimmune diseases, as well as congestion from portal hypertension.
In a child with an acute abdomen, as in acute appendicitis, special techniques are helpful, such as checking for involuntary rigidity, rebound tenderness, a Rovsing's sign, or a positive psoas or obturator sign (see p. 347-348).
A hypospadias is present when the urethral orifice appears at some point along the ventral surface of the glans or shaft of the penis (see Table 17-17, The Male Genitourinary System, p. 776). The foreskin is incompletely formed ventrally.
A fixed, downward bowing of the penis is a chordee; this may accompany a hypospadias.
In newborns with an undescended testicle (cryptorchidism), the scrotum often appears underdeveloped and tight, and palpation reveals an absence of scrotal contents (see Table 17-17, The Male Genitourinary System, p. 776).
Two common scrotal masses in newborns are hydroceles and inguinal hernias; frequently both pressure by crying. See if your fingers can get above the mass, trapping it in the scrotal sac. Apply gentle pressure to try to reduce the size of the mass and note any tenderness. Note whether it transilluminates.
coexist, and both are more common on the right side. Hydroceles overlie the testes and the spermatic cord, are not reducible, and can be transilluminated (see photo at left). Most resolve by 18 months. Hernias are separate from the testes, are usually reducible, and often do not transilluminate. They do not resolve. Sometimes a thickened spermatic cord is noted (called the silk sign).
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