**Question:** Penis is curved in downward direction in all types of hypospadias except -

**Core Concept:** Hypospadias is a congenital anomaly characterized by the urethral meatus being located on the ventral aspect of the penis instead of the glans penis. The normal curvature of the penis is downward, which helps in expelling urine during micturition. In hypospadias, this curvature is altered.

**Why the Correct Answer is Right:** In hypospadias, the urethral meatus is located in an abnormal position, usually on the ventral aspect of the penis. There are different types of hypospadias, such as distal, middle, and proximal. In all types, except for the proximal hypospadias, the penile curvature remains downward, allowing urine to be expelled during micturition. In proximal hypospadias, the urethral meatus is located closer to the base of the penis, and hence, the penile curvature is altered, making it more difficult for urine to be expelled.

**Why Each Wrong Option is Incorrect:**

A. The downward curvature of the penis helps in expelling urine during micturition in hypospadias. This option is incorrect because the downward curvature is preserved in all types of hypospadias, except for the proximal variety.

B. The downward curvature of the penis helps in expelling urine during micturition in hypospadias. Similar to option A, this option is incorrect because, even in distal and middle types, the downward curvature aids in urine expulsion.

C. Distal hypospadias has an altered curvature of the penis. This option is incorrect as the downward curvature is preserved in distal and middle types, allowing urine to be expelled effectively.

D. The downward curvature of the penis helps in expelling urine during micturition in hypospadias. Similar to options A and B, this option is incorrect because the downward curvature is present in all types of hypospadias, except for the proximal type, where the curvature is altered.

**Clinical Pearl:** In cases of hypospadias, the downward curvature of the penis is crucial for effective urine expulsion during micturition. This principle is generally preserved in distal and middle hypospadias, while in proximal hypospadias, the altered curvature can lead to difficulties in urine expulsion.