How to diagnose hypospadias in uncircumcised neonate?

[platon24]

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OK so my peds attending showed us what hypospadias looks like on an uncircumcised boy, and told us about for hypospadias you cant do a circumcision at birth, you need to get a urologist involved so they can remove the foreskin and use it to repair the hypospadias.

However, I dont understand something. It seems to me that the only way you can know if a boy has hypospadias is to pull back the foreskin. That opening seems to tiny for me to see what is going on in there.

How do you know that an uncircumcised child has hypospadias? The opening in the foreskin seems too small to pull back over the head of the penis. Do you have to just put more force on it or what?

Another related question -- isnt pulling back the foreskin on an uncircumcised baby a risk factor for phimosis? I thought you werent supposed to mess with it. Is it one of those things where retracting the foreskin only causes problems if you do it over and over again?

 

[Kahreek]

inspection is the keyword.
If you are gentle there is no problem to pull the foreskin.
Some physician will tell you that not pulling the foreskin is a risk factor phimosis, and it it advised to do so while bathing the baby.
In most cases you wont need to fully retract the skin to check it anyway.

 

[Stitch]

Most cases (I think) will have abnormalities on inspection that you can find prior to circumcision. The appears of two meatuses (meati?), abnormal foreskin that doesn't fully enclose the glans, chordee.

I was always taught not to pull back the foreskin.