A1. Physical examination of the genitourinary tract

From greek.doctor
  • Kidney
    • Inspection
      • Oedema -> inflammation
      • Mass if it’s very large
    • Palpation
      • Bimanual kidney palpation/ballotation method
      • Mass if it’s very large or thin patient
    • Percussion
      • Painful -> pyelonephritis or stones (inflammation or obstruction)
    • Auscultation
      • Bruit in area of costovertebral angle -> renal artery stenosis
  • Urinary bladder
    • Palpation
      • Palpable if 150 mL urine
        • Palpable with less urine in children (in them the bladder is intraabdominal)
    • Percussion
      • If 150 mL urine
  • Penis
    • Inspection
      • Inspect under foreskin
        • Hygiene
      • Skin lesions
        • STI, syphilis
      • Circumcision
      • Phimosis
      • Location of penal meatus (hypospadias, epispadias)
    • Palpation
      • Fibrous plaque -> Peyronie disease
      • Induration of urethra -> periurethritis or stricture
  • Scrotum and testes
    • Inspection
      • Skin lesions
      • Left testicle lower than right
      • Presence/absence of testes
    • Palpation – with fingers from both hands
      • Look for masses
      • Check for inguinal hernia (ask patient to cough)
    • Transillumination – all scrotal masses should be transilluminated
      • Fluid-filled lesions like hydrocele will radiate reddish light
      • Solid tumours won’t
  • Epididymis
    • Only palpation
    • On posterolateral aspect of testicle
    • Tenderness and/or induration -> infection
  • Prostate
    • Digital rectal examination
    • 5 qualities of the prostate
      • Size
        • Normal -> peanut/walnut size
      • Surface
        • Smooth surface -> normal
        • Rough surface -> carcinoma
      • Tenderness
        • Non-tender -> normal
        • Tender -> prostatitis
      • Consistency
        • Normally, the consistency should be like the thenar region of the palm
        • Hard -> carcinoma or acute prostatitis
        • Glandular -> chronic prostatitis
      • Symmetricity
        • Symmetric -> normal or BPH
        • Asymmetric -> carcinoma
    • Procedure
      • Examine sphincter tone
      • Examine the whole ampulla
      • Examine the 5 qualities of the whole prostate
  • Vulva and vagina
    • Inspection
      • Skin lesions
      • Discharge -> STD
      • Congenital malformations
      • Postmenopausal vaginitis
    • Palpation
      • Urethra can be palpated through the anterior wall of the vagina
      • Stone, tumour, etc.