Physical examination of the genitourinary tract: Introduction

The history will suggest whether a complete or partial examination is

Examination of the Kidneys Inspection

Examination of the Kidneys Inspection

The presence and persistence of indentations in the

Palpation

The kidneys lie rather high under the diaphragm and lower ribs

Palpation

The kidney is lifted by one hand in the costovertebral angle.

Palpation

On deep inspiration, the kidney moves downward; when it is lowest,

Palpation

The kidney sometimes can be palpated best with the examiner standing

Palpation

Anomalies were found in 0.5% of 11,000 newborns.

Palpation

An enlarged renal mass suggests compensatory hypertrophy (if the other kidney

Palpation

Tumors may have the consistency of normal tissue; they may also

Palpation
This may be elicited by palpation or, more sharply, by percussion

Percussion

At times, a greatly enlarged kidney cannot be felt on palpation,

Transillumination

Transillumination may prove quite helpful in children under age 1 year

Transillumination

The fiberoptic light cord, used to illuminate various optical instruments, is

Differentiation of Renal & Radicular Pain
Radicular pain is commonly felt in

Differentiation of Renal & Radicular Pain

Frequent causes are poor posture (scoliosis,

Differentiation of Renal & Radicular Pain

Radicular pain may be noted as

Differentiation of Renal & Radicular Pain

Radiculitis usually causes hyperesthesia of the

Auscultation

Bruits over the femoral arteries may be found in association with

Examination of the Bladder

The bladder cannot be felt unless it is

Examination of the Bladder

A sliding inguinal hernia containing some bladder wall

Examination of the Bladder

Bimanual (abdominorectal or abdominovaginal) palpation may reveal the

Examination of the External Male Genitalia
Penis
Inspection

If the patient has not been circumcised, the foreskin should be

The scars of healed syphilis may be an important clue. An

Meatal stenosis is a common cause of bloody spotting in male

The position of the meatus should be noted. It may be

Palpation

Palpation of the dorsal surface of the shaft may reveal a

Urethral Discharge

Urethral discharge is the most common complaint referable to the

Urethral Discharge

Although gonorrhea must be ruled out as the cause of

Urethral Discharge

Bloody discharge should suggest the possibility of a foreign body

Scrotum

Angioneurotic edema and infections and inflammations of the skin of the

Elephantiasis of the scrotum is caused by obstruction to lymphatic drainage.

Testis

The testes should be carefully palpated with the fingers of both

Testis

A hydrocele will cause the intrascrotal mass to glow red.

Testis

About 10% of tumors are associated with a secondary hydrocele that

Testis

The atrophic testis (following postoperative orchiopexy, mumps orchitis, or torsion of

Epididymis

The epididymis is sometimes rather closely attached to the posterior surface

Epididymis

In the acute stage of epididymitis, the testis and epididymis are

Epididymis

Chronic painless induration should suggest tuberculosis or schistosomiasis, although nonspecific chronic

Spermatic Cord & Vas Deferens

A swelling in the spermatic cord may

Spermatic Cord & Vas Deferens

Careful palpation of the vas deferens may

Spermatic Cord & Vas Deferens

When a male patient stands, a mass

Testicular Tunics & Adnexa

Hydroceles are usually cystic but on occasion are

Testicular Tunics & Adnexa

Hydrocele usually surrounds the testis completely.

Examination of the Female Genitalia

Vaginal Examination
Diseases of the female genital tract

Inspection

In newborns and children especially, the vaginal vestibule should be inspected

Inspection

Biopsy is indicated if a malignant tumor cannot be ruled out.

Inspection

The diagnosis of senile vaginitis (and urethritis) is established by staining

Inspection

Multiple painful small ulcers or blisterlike lesions may be noted; these

Inspection

The presence of skenitis and bartholinitis may reveal the source of

Inspection

They are often found in association with stress incontinence.

Palpation

A soft mass found in this area could be a urethral

Palpation

A stone in the lower ureter may be palpable. Evidence of

Palpation

Rectal examination may afford further information and is the obvious route

Rectal Examination in Males

Sphincter & Lower Rectum
The estimation of sphincter tone

Prostate

A specimen of urine for routine analysis should be collected before

Size

The average prostate is about 4 cm in length and width.

Consistency

Normally, the consistency of the gland is similar to that of

Consistency

Generally speaking, nodules caused by infection are raised above the surface

Consistency

At their edges, the induration gradually fades to the normal softness

The prostate-specific antigen (PSA) level can be helpful if elevated. Transrectal

Mobility

The prostate should be routinely massaged in adults and its secretion

Mobility

It should not be massaged, however, in the presence of an

Massage & Prostatic Smear

Copious amounts of secretion may be obtained from

Massage & Prostatic Smear

Microscopic examination of the secretion is done under

Massage & Prostatic Smear

The presence of large numbers of pus cells

Massage & Prostatic Smear

On occasion, it may be necessary to obtain

Seminal Vesicles

Palpation of the seminal vesicles should be attempted. The vesicles

Seminal Vesicles

Stripping of the seminal vesicles should be done in association

Lymph Nodes
It should be remembered that generalized lymphadenopathy usually occurs early

Inguinal & Subinguinal Lymph Nodes

Such diseases include chancroid, syphilitic chancre, lymphogranuloma

Inguinal & Subinguinal Lymph Nodes

Malignant tumors (squamous cell carcinoma) involving the

Other Lymph Nodes

Tumors of the testis and prostate may involve the

Neurologic Examination

A careful neurologic survey may uncover sensory or motor impairment

Neurologic Examination
The bulbocavernosus reflex is elicited by placing a finger in

Neurologic Examination
It is wise, particularly in children, to seek a dimple

NONSPECIFIC INFLAMMATORY DISEASES OF GENITOURINARY ORGANS

Nonspecific inflammatory diseases of genitourinary organs:

Acute pyelonephritis
Chronic pyelonephritis

Nonspecific inflammatory diseases of genitourinary organs:

Cystitis
Paracystitis
Urethritis

Nonspecific inflammatory diseases of genitourinary organs:

Prostatitis
Vesiculitis

Pyelonephritis

is nonspecific inflammatory infectious process, in which the parenchyma and

Pyelonephritis

Patients with acute pyelonephritis present with chills, fever, and costovertebral angle

Pyelonephritis

Sepsis may occur, with 20–30% of all systemic sepsis resulting from

Pyelonephritis

Bacteria are cultured from the urine when the culture is obtained

Pyelonephritis

The infection penetrates into the kidney by two routes:
Hematogenous

Pyelonephritis

Of the local factors contributing to origination pyelonephritis most often

Factors, which promote development of acute pyelonephritis

Stones of the kidney
Ureter and

The triad of symptoms of acute pyelonephritis

High body temperature
Pain in

Acute Pyelonephritis
Of great value for diagnostics are the laboratory methods of

Acute Pyelonephritis

Radiological researches in patients with AP are necessary to

Acute Pyelonephritis

Treatment of primary AP in most cases is conservative

Acute Pyelonephritis treatment

The management of acute pyelonephritis depends on the severity of

Acute Pyelonephritis treatment

Empiric therapy with intravenous ampicillin and aminoglycosides is effective against

Acute Pyelonephritis treatment

Fever from acute pyelonephritis may persist for several days despite

Acute Pyelonephritis treatment

In patients who are not severely ill, outpatient treatment with

Vesicoureteral Reflux

Approximately 50% of patients with the infection of urinary

Classification of Vesicoureteral Reflux according to its grades:

Grade I: a contrast

Classification of Vesicoureteral Reflux according to its grades:

Grade IV: moderate dilatation

Treatment of Vesicoureteral Reflux

Antibacterial treatment is directed to prevention of

Treatment of Vesicoureteral Reflux

Indications for operative treatment:
Inefficient conservative treatment

Secondary Acute Pyelonephritis

Differs from primary in a clinical picture by

Cause of Secondary Acute Pyelonephritis

Stones of the kidney and ureter

Chronic Pyelonephritis

The diagnosis is made by radiologic or pathologic examination rather

Chronic Pyelonephritis

Many individuals with chronic pyelonephritis have no symptoms, but they

Chronic Pyelonephritis

Main X-ray signs are:
Deformations of the pyelocaliceal system

Chronic Pyelonephritis

Main X-ray signs are:
Changes of dimensions and contours of the

Chronic Pyelonephritis

Renal scarring induced by UTIs is rarely seen in adult

Chronic Pyelonephritis

In these patients, urinalysis may show leukocytes or proteinuria but

Treatment of Chronic Pyelonephritis

Removal of causes produsing the disturbance of urine

Chronic Pyelonephritis management

The management of chronic pyelonephritis is somewhat limited because renal

Chronic Pyelonephritis management

Long-term use of continuous prophylactic antibiotic therapy may be required

Chronic Pyelonephritis management

Rarely, removal of the affected kidney may be necessary due

Necrosis of Renal Papillae

Bacteriemic Shock

Pyonephrosis

means the final stage of specific or nonspecific purulent-destructive inflammatory

Apostematous Pyelonephritis

represents a purulent-inflammatory process with the formation of numerous,

Renal Abscesses

Renal abscesses result from a severe infection that leads to

Renal Abscesses

When the abscesses extend beyond the Gerota's fascia, paranephric abscesses

Renal Abscesses

With the development of effective antibiotics and better management of

Renal Abscesses

Abscesses that form in the renal cortex are likely to

Renal Abscesses management

The appropriate management of renal abscess first must include appropriate

Renal Abscesses management

The drained fluid should be cultured for the causative organisms.

Renal Abscesses management

If the abscess still does not resolve, then open surgical

Pyonephrosis

Pyonephrosis refers to bacterial infection of a hydronephrotic, obstructed kidney, which

Pyonephrosis

Patients with pyonephrosis are usually very ill, with high fever, chills,

Pyonephrosis management

Management of pyonephrosis includes immediate institution of antibiotic therapy and drainage

Pyonephrosis management

Extensive manipulation may rapidly induce sepsis and toxemia.

Pyonephrosis management

In the ill patient, drainage of the collecting system with a

Acute Cystitis

The most common causative agent of cystitis is E.Coli,

Acute Cystitis

Acute cystitis refers to urinary infection of the lower

Acute Cystitis

The diagnosis is made clinically. In children, the distinction

Acute Cystitis

Patients with acute cystitis present with irritative voiding symptoms

Acute Cystitis

Urine culture is required to confirm the diagnosis and

Acute Cystitis

E coli causes most of the acute cystitis. Other

Acute Cystitis Management

Trimethoprim-sulfamethoxazole and nitrofurantoin are less expensive and thus

Acute Cystitis Management

In adults and children, the duration of treatment