Physical Exam of the GUS power point.pptx

Genital Urinary system

1. PHYSICAL EXAM OF THE GENITAL URINARY SYSTEM Presenter: Dr. Bukenya Ali Moderator: Mr. Namiisi 24 TH /Sept/2025

2. The urologist can undertake the initial evaluation and establish a diagnosis for almost all patients with diseases of the GU system. A complete history and appropriate physical examination are critical in the assessment of urologic patients. A complete urinalysis, including chemical and microscopic analyses, should be performed because this may provide important information critical to the diagnosis and treatment of urologic patients. KEY POINTS

3. Why the Physical Exam Remains Paramount Cornerstone of Diagnosis: The history and physical exam are critical for initial evaluation and diagnosis of GU diseases. Guides Advanced Testing: Simplifies the selection of appropriate, cost-effective laboratory and radiologic studies. Dynamic Assessment: Provides functional and tactile information (e.g., organ mobility, tenderness) not available from static imaging like CT or MRI. Essential Action: A complete urinalysis (chemical and microscopic) is a mandatory first-line investigation. Introduction & Foundational Importance

4. The Patient as a Whole: Identifying Systemic Stigmata Nutritional Status: Cachexia (malignancy) vs. specific obesity patterns (Cushing's: truncal obesity, buffalo hump, striae). Skin Findings: Jaundice, pallor, hyperpigmentation (Addison's), or peripheral edema (cardiac, renal, or lymphatic obstruction). Lymphadenopathy: Supraclavicular nodes: Associated with advanced prostate/testis cancer. Inguinal nodes: Suggest carcinoma of the penis or urethra. Gynecomastia: Indicator of endocrinopathy, alcoholism, or prior hormonal therapy. General Observation & Systemic Clues

5. Assessing the Retroperitoneal Organs Anatomical Challenge: Kidneys are retroperitoneal, well-protected, and often non-palpable in adults, especially men. Technique (Bimanual Palpation): 1. Place one hand in the costovertebral angle (posterior). 2. Press firmly with the other hand below the costal margin (anterior). 3. Ask the patient to inspire deeply; the kidney may descend onto the examining hand. Percussion: Crucial for localizing tenderness in suspected pyelonephritis or obstruction (Costovertebral Angle Tenderness - CVA). Auscultation: Listen for systolic bruits suggesting renal artery stenosis. Kidney Examination: Palpation & Percussion

6. EXAMINATION OF THE KIDENYS

7. Detecting Urinary Retention and Masses Palpation/Percussion: The normal bladder is impalpable. Percussion is superior for detecting distension. Technique: Percuss from symphysis pubis upward; a dull note indicates the bladder dome. Bimanual Examination (Under Anesthesia): Gold Standard for staging bladder tumors. Assesses induration, nodularity, and mobility of the bladder and pelvic masses. Performed abdominally and vaginally (female) or rectally (male). Bladder Examination

8. EXAMINATION OF THE INGUINAL CANAL

9. Inspection and Palpation for Anatomical & Pathological Findings Foreskin Retraction: Essential in uncircumcised men to inspect for balanoposthitis, premalignant lesions, or carcinoma. Urethral Meatus: Note position (hypospadias/epispadias) and inspect for discharge. Shaft Palpation: Dorsal: Palpate for fibrotic plaques of Peyronie's disease. Ventral: Tenderness may indicate periurethritis from a stricture. Skin Inspection: Assess for ulcers (STI/tumor), vesicles (herpes), or condylomata . Penis and Urethral Meatus Examination

10. Penis and Urethral Meatus Examination

11. Differentiating Benign from Malignant Pathology Testes Palpation: Assess size, consistency, and symmetry. A firm, hard nodule is testicular cancer until proven otherwise. Epididymis & Cord: Palpate the epididymal ridge posteriorly. Masses here (cysts, spermatoceles) are typically benign. Hernia Examination: Invaginate the scrotum to the external inguinal ring. Patient performs Valsalva; a bulge indicates a hernia. Varicocele: A "bag of worms" sensation, best appreciated with the patient standing during Valsalva. Transillumination: Differentiates cystic (hydrocele) from solid (tumor) masses. Scrotum and Contents: A Methodical Approach

12. Scrotum and Contents: A Methodical Approach

13. Technique, Findings, and Clinical Significance Indications: Routine screening >40 years; any urologic complaint. Patient Positioning: Standing, bent over the table, or knee-chest position. Ensure patient relaxation and privacy. Key Assessment Points: Anal Sphincter Tone: Flaccid or spastic tone may indicate neurogenic bladder. Prostate Gland: Size (chestnut-sized normal), consistency (rubbery), nodularity, tenderness. Rectal Mucosa: Palpate for masses to detect colorectal cancer. Post-Procedure: Always test stool for occult blood (guaiac test). Male Digital Rectal Examination (DRE)

14. Male Digital Rectal Examination (DRE)

15. A Collaborative and Comprehensive Assessment Mandatory: A female chaperone must always be present. Inspection (Lithotomy Position): External genitalia, introitus, urethral meatus (for caruncles, prolapse). Valsalva Maneuver: Assess for cystocele, rectocele, and stress incontinence. Palpation: Urethra: For induration (cancer) or diverticula (may express pus). Bimanual Exam: Assess bladder, uterus, and adnexa for masses. Further Imaging: Any abnormality warrants pelvic ultrasound/CT. Female Pelvic Examination

16. Female Pelvic Examination

17. Assessing Sacral Nerve Integrity Sensory Mapping: Deficits in the S2-S4 dermatomes (saddle area) suggest sacral nerve root damage. Bulbocavernosus Reflex (BCR): Test: Squeeze the glans/clitoris or tug on the Foley catheter while monitoring the anal sphincter contraction. Significance: Tests the integrity of the S2-S4 reflex arc. Absence suggests neurologic dysfunction. Cremasteric Reflex: Stroking the inner thigh causes testicular retraction. Limited neurologic utility but helpful in evaluating testicular pain in children. Neurologic Examination in Urology

18. Systematic is Strategic: A thorough, systematic exam is indispensable for accurate diagnosis. Context is Key: Findings must be interpreted within the context of the patient's full history. Bridge to Technology: The physical exam should guide, but not be replaced by, advanced diagnostic imaging. Thank You – Questions? Key Takeaways & Conclusion