Hypospadias, cryptorchidism and common male genital disorders: Case

This boy has two findings that together change the management. The left testis, still palpable in the inguinal canal and not in the scrotum at seven months, is a true undescended testis that will not now descend spontaneously and needs orchidopexy within the 6 to 18 month window. The ventral glanular meatus with the hooded prepuce is a distal hypospadias, and its coexistence with the undescended testis raises the question of a disorder of sex development and absolutely forbids circumcision. [9] [1]

Clinical findings

The key findings are the palpable undescended left testis that cannot be milked into the scrotum, which distinguishes it from a retractile testis that would stay down once brought to the bottom of the scrotum, and the distal hypospadias with the hooded prepuce and the slightly ventral meatus. [1] The examination was correctly performed in the warm room in the frog-leg position, which relaxes the cremaster and is the essential precondition for an accurate assessment of testicular position in the infant. [9]

The coexistence of the two findings is the clinically important point. A hypospadiac meatus together with an undescended testis raises the probability of an underlying chromosomal or endocrine abnormality, and although this boy has a unilateral and palpable testis rather than the more worrying bilateral non-palpable presentation, the combination still warrants consideration of a disorder of sex development and discussion with the urology and endocrinology teams. [9]