A1. Physical examination of the genitourinary tract

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.