Basic Physical Examination In

Urology
Wendell Ken , MD
General Surgeon

Department Of Surgery
Faculty of Medicine Christian University of Indonesia
Jakarta
2013
A. History taking

* Chief complain :
- Something that makes patient visit the doctor
For examples :
- colic - malaise
- fever - frequency
- mass - trauma
- hematuria - dysuria
- hesitancy - dribbling
- abnormality of urinary stream - enuresis
- incontinence - flank pain
- urethral discharge - congenital anomaly
- smoking (too much) - sexual dysfunction

It must be communicative and understandable !

* Age :
- Work at ……….. Retired from ………..
- tire fabrique
- plastic carcinogenic material
- tar
- Woman : - marital status: - how long
- number of children
- age of children
- labor status : - catheterization
- forceps
- perineal tear
- Catamenia : - menarche
- climacterium
- menopause
* Previous disease and history of family illness :
- veneral disease, DM
- tuberculosis
- chronic & severe disease
only lying on bed
- bouginage
- urogenital trauma
- surgery
- menstrual cycle (women)
- tropical / hot country (stone disease)
- imported disease (schistosomiasis)
* Laboratory form
* Take sample
B. Urologic Examination
1. General condition :
a. don’t be hurry  skip something !
b. check every system & organ systematically
(not only urogenital organ !)
c. observe the patient when he or she comes to
examinating room :
* normal walk
* assisted
* on wheel chair
* crooked
d. Examine:
- vital signs
- wasting / reduced body weight
- tension, depression, pale, painfull

2. Abdominal examination
a. The precence of enlargement of kidney,
bladder, and other organs
b. Groin: - hernia: lateral, femoral
- varicous saphena vein
- enlargement of lymph node
c. In male patient, examine:
- penis and urethra
- scrotum : testis, epididymis, vas deferens,
varicocele
3. Digital rectal examination (rectal toucher)

------> male
Assess:
- sphincter tone
- ampulla recti
- mucous line
- prostate
- seminal vesicle
- base of the bladder
4. Examination for female patient
- vulva
- urethra
- vagina -----> - vaginal toucher (palpation)
- speculum
Special examination on :

Kidney :
- Enlargement: round mass in the flank, moved
with breathing, palpate with two hands
(bimanual) -----> ballotement
- Fist pain on costovertebral angle:
a. perform carefully
b. sitting position
Bladder :
- Enlargement : round mass on lower abdomen
a. above symphyseal pubic
b. cystic on palpation
c. percussion: dull
Groin :
• Patient position :
- lay down / supine
- stand up
• To assess :
- varicocele
- hernia
- enlargement of groin lymph node
- varicous saphena vein
Scrotum (and the contents) :
• the presence / absence of scrotal
enlargement / the contents
• if there is a scrotal enlargement -----> hernia /
not -----> palpate inguinal region
• if there is content of scrotum, assess : solid /
cystic
• if cystic -----> assess the position to testis
• posterior to the testis --> epididymal cyst
• cystic mass surrounding testis -->
hydrocele --> diapanoscopy (+)
Diapanoscopy
• The presence / absence of varicocele
• Palpate vas deferens
• If we find a solid mass (testis) ----->
suspicious of neoplasma
• If there is an enlargement of epididymis
-----> inflammation
• Difficulties to differentiate between:
orchitis and torsion of testis ----->
the history is essential!
Penis and urethra :
- circumcised / not
- phymosis / paraphymosis
- inflammation, edema
- tumor
- hypospadia, epispadia
- urethral discharge
Digital rectal examination (DRE):
• Simm’s position
• Knee chest position
• Lithotomy position
-----> empty the bladder before perform DRE
• Assess the prostate gland :
- palpaple / not
- enlargement -----> compare to normal size
- smooth / irregular / asymetris
- consistency of the prostate
- the presence of node
Digital Rectal Examination
Digital Rectal Examination
Digital Rectal Examination
Prostatic
Nodule
Urologic examination for female patients :
- vulva
- urethra
- vagina
- the presence of urine drop pass away
from vagina
- vaginal toucher: only for married woman
Conclusions
History nearly all
Complete and accurate diseases
physical examination can be
diagnosed

Laboratory finding - confirmation

Additional test - treatment
- follow up
Medical record should be :
• simple
• solid
• relevance
• include all investigation results:
anamnesis, history of the present illness
and previous illness, physical
examination, diagnosis, and treatment
plan
Bimanual
Kidney
Palpation
Bimanual Kidney Palpation
Bimanual
Kidney
Palpation
Kidney Palpation
Kidney Palpation In Lying Side Position
Flank
pain
Refered Pain
In Urinary
Tract
 Punch Test In
Costo-vertebral
Angle
Abdominal Mass
In Children
(Wilm’s Tumor)
 Flank Mass
(Perinephric
Abscess)
Suprapubic
Mass
(FullBladder)
Percussion
On Full
Bladder
Bladder Position In Full Bladder
Bimanual Bladder Palpation (Male)
Bimanual
Bladder
Palpation
(Female)
Extrophie
Bladder
Hypospadias
&
Epispadias
Phymosis
 ‘Second
Bladder’ On
Phymosis
Paraphymosis
Condyloma Accuminata
Penile
Cancer
Palpation
The
Dorsum
Penis
Palpation The Urethra
 Urine
Extravasation
Caruncula
Urethrae
Palpation Funiculus & Vas Defferens
Unilateral Undescensus Testiculorum (Left)
Bilateral Undescensus Testiculorum
Torsio
Testis
(Left)
Epididymitis Tuberculosa
Hydrocele Testis (Right)
Thank You