‘MALE’ GENITOURINARY EXAMINATION
Inspection
- A. Skin and pubic hair
- B. Penis
- If uncircumcised, retract foreskin and inspect for:
- Ulcers, warts, inflammation
- Phimosis (inability to retract foreskin over glans)
- Paraphimosis (inability to reduce foreskin after having retracted it - EMERGENCY)
- Smegma (cheesy, white material under the foreskin – normal)
- Meatus – hypospadias (meatus on underside of penis) or epispadias (meatus on upper surface of penis)
- C. Scrotum (with patient standing) – and know to transilluminate if swelling present
- D. Inguinal Region
- Masses
- Bulges – most often due to inguinal hernias
- Swellings – may be inguinal lymphadenopathy, infections, or possible malignancies of the lower limbs, scrotum, or perineum
Palpation
A. Lymph Nodes (don’t need to know what lymphatics drain where—just know that many drain to inguinal or iliac lymph nodes)
B. Penis (don’t worry about the details)
C. Scrotal Contents
- Testicles
- If a mass is present attempt to position your finger above the mass – if you are unable to do so, the mass is likely due to an inguinal hernia, if you are able to do so the mass likely originates within the scrotum
- Any hard mass is malignant until proven otherwise!
- Epididymis and Spermatic Cord
D. Inguinal Region (palpation of hernias) - know how to differentiate between direct inguinal, indirect inguinal, and femoral hernias on exam
Percussion
A. Kidneys
Percuss the costovertebral angles bilaterally, if pyelonephritis is suspected with fever; possible tenderness on percussion
B. Bladder (not commonly done – I will not test you on this)
Indication
Landmark/anatomy
Introduction
- Hand wash
- Name
- Explain exam to the patient
General Inspection
General Inspection
Position
Explain the exam to the patient.
Ask the patient to lie on the examination table in a supine position.
Ask the patient to expose their genitals. Drape appropriately.
Draping
Inspection
Palpation