Urology Examination

by Dr.Issam Ayat

-Empty scrotum: unilateral or bilateral

-scrotal swelling: unilateral or bilateral
1-direct pure scrotal swelling (the origin of swelling is
from scrotum).
2-indirect or not pure scrotal swelling (most likely
originate from inguinal ring 'inguinal hernia').
*types of scrotal swelling:
- painless scrotal swelling:
1-hydrocele: accumulation of serous fluid inside tunica
vaginalis.
2-hematocele: accumulation of blood inside tinica
vaginalis.
*to differentiate between hydrocele and hematocele:
transmation test: is +ve in case with hydrocele and –ve
in case of hematocele.
fluctuation test: is +ve in case with hydrocele and
hematocele.
3-varicocele: dilatation and tortious of pampiniform
plexus or obstruction of spermatic vein, give appearance
of (worm bag), has 4 grades:
-grade 1: can be detected by US (every 6 months).
-grade 2: can be detected by expert doctor.
-grade 3: valsalva maneuver (tell the patient to breath in
deeply then hold his breath, you can feel the dialated
veins) is positive with bag of worm appearance.
-grade 4: obvious dilated pampiniform plexus.
4-pyocele: accumulation of pus inside the tunica va
5-testicular tumor: rarely found, affect young age,
present with unilateral painless hard swelling attach the
skin of the scrotum or cremasteric muscle, with
generalized symptoms (fatigue, loss of appetite and
weight, night swelling), on investigation: positive alpha
feto protein, what is the most typical diagnosis?
- painful scrotal swelling
1-testicular torsion: is more serious and danger, the
patient comes with acute onset sever pain and a
gangrenous testes can be developed > septic shock >
death.

SOCRATES:
site: testes.
onset: acute.

2-epididymo-orchitis: inflammation of epididymis and

testis.

3-epididymitis: inflammation of epididymis, usually

longer than testicular epididymitis (gradual onset),
accompanied with fever, rigors, fatigue ……etc
(symptoms of inflammation).
the most common cause is E.coli , in case of sexually
active in addition to E.coli urethral discharge
(gonorrhoea or chlamydia), STD.
social review must be asked:
are you married ? how long ? do you have children ?

SOCRATES:
site: testes.
onset: gradual onset.
associated symptoms: inflammatory symptoms.

*what is the test to deffirintiate between testicular

torsion and epididymitis?
by Brehn test: elevating the scrotum , in case the pain is
reduced = positive brehn test = epididymitis.
in case the pain is increased = negative brehn test =
testicular torsion.

4-orchitis: inflammation of testis

#Scrotal examination:

1- introduce myself
2- wash your hands
3- explain the procedure
4- take the permission
5- ensure the privacy
6- exposure both genetalia
7- patient should be in standing position, wearing shoes
(the floor could be cold and cause contraction of
cremasteric muscle).
next:
1- inspection: comment on the symmetry (both scrotum
look symmetrical or asymmetrical due to unilateral
swelling or empty scrotum or visible mass),
well developed or not / well mature or not by inspecting
the wrinkles of cremasteric muscle of tetes.
-there is no ulcer / change in color (red in case of
epididymits / there is no scar of aspiration or testicular
tortion)
-then inspect the posterior part of testes to observe any
lesion on the skin such as T.B lesion (extra-pulmonary
signs).
-do cough test: In case of hernia above the inguinal ring
by coughing > increase intra-abdominal pressure >
scrotal swelling related to inguinal hernia, (in case the
testis is swollen before and after cough > pure scrotal
swelling).
‫قول للمريض يتلفت لجنبه اليسار و اطلب منه يكح و الحظ لو زاد االنتفاخ‬

-then test the hotness and tenderness, by touching the

right scrotum and compare the temperature with the
right thigh then touch the left scrotum and compare the
temperature with the left thigh.

2- palpitation:
I can palpate this testis and spermatic cord.
-in case of varicocele, the pampiniform plexus can be
felt as bag of worm.
at the root of the neck of the scrotum close it by two
fingers > if your fingers contact to each others say I can
get above the swelling = pure swelling, if not > say I
can't get above the swelling = indirect swelling (inguinal
hernia.
the swelling could be fluid or mass, the fluid could be
serous or blood.
fluctuation test: compress the swollen testis on the
medial and lateral parts then push and receive.
transmation test: put the x-ray paper on the anterior
side of the testis and the torch on the posterior side of
the testis in dark room, if red/dark light is detected =
hematocele, transparent = hydrocele.

‫ و ما كان من خطأ فمن نفسي‬،ً‫ما كان من صواب فالفضل هلل أوالً و آخرا‬