ANATOMIC REVIEW AND PHYSICAL EXAM OF MALE GENITALIA JAY GILBAUGH, MD CLASS #8, LESSON #15 This lesson will

cover a brief review of male anatomy and common disorders of the male genitourinary tract, prostate and rectum. I. II. INTRODUCTION ANATOMIC REVIEW A. B. C. D. E. F. G. H. III. Penis Scrotum Inguinal Canal Testes Epididymis Spermatic Cord Prostate Gland Seminal Vesicles

GENITOURINARY HISTORY A. B. C. D. E. Previous GU surgeries or conditions Previous urinary tract infections or STDs Testicular pain or mass Penile lesion or discharge Voiding History: 1. 2. 2. 3. quality of urinary stream nocturia - quantitate urinary frequency hesitancy, urgency, double voiding, post-void dribbling or feeling of incomplete emptying dysuria hematuria incontinence

4. 6. 7.

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a) b) E. Sexual history 1. 2. 3. III.

stress urge

quality of libido quality of erections problems with ejaculation

APPROACH TO PHYSICAL EXAMINATION A. General 1. 2. 3. A. Penis 1. Physical exam technique: a) b) c) d) e) f) g) h) inspection of shaft for gross lesions palpate shaft for plaques retract foreskin, if present (except in infants) examine glans for gross lesions examine meatus for size and location evert meatus to inspect fossa navicularis examine for urethral discharge reduce foreskin after exam! Inspection, palpation, transillumination Exam easiest with patient standing Professional, straight-forward approach will minimize patient anxiety

1.

Common abnormalities: a) Shaft

2

(1) (2)

Peyronie's disease skin lesions: (a) (b) (c) herpes condylomata accuminatum (venereal warts) molluscum contagiosum

(3) a) Prepuce (1) (2) a) Glans (1) (1) (2) a) Meatus (1) (2)

Priapism - persistent, prolonged erection

phimosis paraphimosis

balanitis/ balanoposthitis pearly papules chancre/ulcer

stenosis abnormality of position: (a) (b) (c) epispadias hypospadias

A.

Scrotum: 1. Exam technique: a) b) c) inspection for gross lesions palpate for thickness palpate inguinal canal

2.

Common abnormalities: a) b) sebaceous cysts of scrotum scrotal edema

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b)

scrotal erythema (1) (2) yeast infection Fournier's gangrene (necrotizing fasciitis)

d) A. Scrotal Contents 1.

inguinal hernias

Exam technique: a) b) c) d) palpate testis for consistency and masses palpate epididymis for consistency, tenderness and masses palpate vas deferens for presence palpate spermatic cord for varicosities - have patient perform valsalva maneuver check cremasteric reflex

e) . 2.

Common abnormalities: a) Testis: (1) (2) (1) a) hydrocele – transilluminate testicular cancer testicular torsi

epididymis: (1) (2) epididymitis spermatocele (epididymal cyst)

a)

spermatic cord: (1) varicocele

E.

Groin - palpate for presence of inguinal adenopathy

A.

Prostate 1. Exam technique: a) b) use plenty of water-soluble lubricant have patient bear down as if having a bowel movement

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c) 1.

palpate both sides of prostate to compare size, consistency and tenderness

Common abnormalities: a) b) c) prostatic hypertrophy prostatitis syndromes prostate cancer

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