genitourinary disorders
Evaluation of the Urologic Patient
Physical Examination of the Urologic Patient
Physical examination focuses on the costovertebral angle, abdomen, rectum, groin, and genitals. In women with urinary symptoms, pelvic examination is usually done. Pain elicited by blunt striking of the back, flanks, and angle formed by the 12th rib and lumbar spine with a fist (costovertebral tenderness) may indicate Acute pyelonephritis , Visual fullness of the upper abdomen is an extremely rare and nonspecific finding of a kidney or abdominal mass. Dullness to percussion in the lower abdomen suggests bladder distention; normally, even a full bladder cannot be percussed above the symphysis pubis. Bladder palpation can be used to confirm distention and urinary retention. During digital rectal examination, Prostatitis may be detected as a boggy, tender prostate. Focal nodules and less discrete hard areas must be distinguished from Inguinal and genital examination should be done with patients standing. Inguinal hernia or adenopathy may explain scrotal or groin pain. Gross asymmetry, swelling, erythema, or discoloration of the testes may indicate infection, torsion, tumor, or other mass. Horizontal testicular lie (bell-clapper deformity) indicates increased risk of testicular torsion. Elevation of one testis (normally the left is lower) may be a sign of Testicular Torsion . The penis is examined with and without retracting the foreskin. Inspection of the penis can detect Hypospadias or Peyronie Disease in men Priapism , ulcers, and discharge in either group Palpation may reveal an Groin hernias . Cremasteric reflex may be absent with testicular torsion. Location of masses in relation to the testis and the degree and location of tenderness may help differentiate among testicular masses (eg, spermatoceles, 