Male Genitourinary Examination

 

Relationship building is essential - communicate well! Appreciate and respect cultural or religious beliefs.

Reqest the patient's permission and let them know who you are.

 

Ask if the patient needs privacy to remove clothing, and use a drape to limit exposure.

Allow the patient to cover up when finished, and offer a tissue to clean up.

 

Before beginning, check for hernias or variocoeles.

Explain the procedure to the patient, using models or diagrams. Address concerns about pain. Be honest 'this might be a bit uncomfortable'

Having an assistant in the room is a good idea.

 

Review the anatomy

penis: foreskin, glans, and urethral meatus

scrotum: testis, epididymis, spermatic cord

hernias

anus, rectum

 

equipment required:

light

gloves

Always wear gloves!

  • inspection
  • palpation
  • digital rectal exam

Inspection

penis

  • balanitis: inflammation/infection of the foreskin (poor hygeine, diabetes)
  • hypospadias - urethral opening along penis
  • condyloma
  • herpes virus
  • syphilitic ulcers
  • squamous cell carcinoma
  • candidiasis

scrotum: from standing position

 

Palpation

teach patients to do the same as you proceed.

shaft: plaques (ie Peyronie's Disease)

urethral strictures

 

scrotum: spermatic cord, ep

use thumb and fingers to palpate each testicle, orderly and routinely. Note the size, softness, tenderness, masses (hydrocele, spermatocele, torsion, testicular cancer, epididymitis, orchitis, hernia)

follow the cord structures up to the external ring

 

spermatic cord:

varicoceles: "bag of worms"

 

hernias:

find external ring (deep inside), get patient to

digital rectal exam

positioning is very important: leaning over the table, resting on elbows, or lying on side, flexing elbows and knees

sitting is easier..

start gently, then proceed more firmly

feel size (normally 4x4 cm)

take a pciture... (to feel, finger to thumb: thenar muscle = normal; palm = boggy; thumb joint = nodule)

describe prostate as: smooth, symmetrical, with no hard nodules;

abnormal: asymmetrical, firm area, hard nodule, "boggy", enlarged

 

examine the prostate sequentially; along each obe, to the furrow

 

note anal tone, rectal masses, warts, melanoma, hemorrhoids,