The key feature is that the whole glans is visible, which cannot happen in phimosis, when the glans is hidden under the very tight foreskin. Treatment requires surgical referral. It is only the rare co-operative child that allows you to gently compress the oedema and reduce the paraphimosis without an anaesthetic. Occasionally, EMLA cream will facilitate successful reduction. Usually elective circumcision is booked for 6 weeks, although occasionally the foreskin becomes stretched during the episode of paraphimosis and requires no further treatment.
Textbooks say that hydroceles are a scrotal swelling that the examiner can easily get above.
In practice, this is not always so, as the swelling can extend up towards the deep inguinal ring. Do not order an ultrasound. Every infant with bilateral undescended testes should be examined for the possibility of ambiguous genitalia, especially if the penis is abnormal. If in doubt, consult. Some testes can descend in the first few months after birth, so if a testis can be felt in the groin, it is reasonable for you to review the patient at 6 months, before referring.