ABSTRACT
Previous circumcision (can be carried out for medical or religious reasons)
• Site of urethral meatus Hypospadias (the meatus is ventral and more proximal than normal)
Epispadias (the meatus is dorsal)
Both of these conditions are congenital but can be an indication of underlying abnormalities such as undescended testicles, chromosomal disorders or Klinfelter’s syndrome
• Evidence of infection Balanitis (inflammation of the glans penis) Warts
Sebaceous cysts
Sexually transmitted infections
• Any swellings Papules (small raised lumps/lesions above the skin, <5 mm)
Hair follicles
Sebaceous glands
Nodules (same as papule but larger <10 mm)
Tyson’s glands (‘pearly papules, skin coloured around the circumference of the glans’ crown, often mistaken for warts, but are non-infectious)
Molluscum contagiosum
Genital warts
Lichen planus
Psoriasis
Dermatitis
Balanitis
Can be due to poor hygiene
Plaques (palpable lesions >10 mm in diameter that are elevated above the skin surface)
Psoriasis
Molluscum contagiosum (larger lesions seen in acquired immunodeficiency syndrome (AIDS) patients)
Erythroplasia of Queyrat (solitary or multiple erythematous plaques, can be precancerous)
Macules (completely flat, change in skin colour or texture)
Lichen sclerosus/balanitis xerotica obliterans can degenerate into penile cancer
• Ulceration Single ulcer Primary syphilis
Chancroid lymphogranuloma (chlamydial infection
which infects squamocolumnar epithelial cells)
Penile carcinoma
Multiple ulcers Secondary syphilis
Herpes simplex/zoster
Penile carcinoma
Chronic ulceration Pemphigus vulgaris (a rare, relapsing autoimmune disease causing blistering of the skin and mucous membranes, e.g. mouth, nose, throat and genitals)
Behcet’s disease (an autoimmune disorder causing inflammation, especially of the small blood vessels – vasculitis)
Reiter’s syndrome (autoimmune condition that develops in response to an infection in another part of the body, usually affecting joints, eyes and urethra)
• Urethral discharge Is uncommon without infection The presence of skin lesions or discharge may require sampling of the area via swabs or biopsy
• Parasites Pediculosis (lice) Pthirus pubis (crab louse)
• Scrotum for skin abnormalities Fungal infections Sebaceous cysts
Sexually transmitted infections
Unusual thickening of the scrotal sac may be caused by generalized fluid retention as in cardiac, hepatic or renal disease
Palpate the
• Penis: almost all of the examination of the penis is carried out by inspection; palpation is only indicated when an abnormality is present. Ask patient to withdraw foreskin and then replace after examination
• Scrotum for Presence of the testes Undescended testicles
Abnormal painful swelling Acute epididymitis
Orchitis
Torsion of the spermatic cord
Strangulated inguinal hernia
Non-tender swellings (Fig. 6.1) Indirect inguinal hernias
Transilluminate testing will help to differentiate between fluid-filled swellings or solid tissue. Fluid-filled swellings transmit light (e.g. hydrocele and spermatocele) whereas solid masses do not
Sebaceous cysts are common in the superficial skin of the scrotum
Varicocele (abnormal enlargement of the veins in the scrotum) (negative to transillumination)
Spermatocele (benign retention cyst)
Hydrocele (a fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord)
• Testicles Should be smooth, rubbery and free of nodules, sensitive but not tender
Abnormalities may indicate infection or the presence of a cyst or tumour. Testicular cancer is usually a hard non-tender nodule. If suspected check for gynaecomastia
Soft, small testicles may indicate cirrhosis or hypogonadism
If absent check along their line of descent
Cryptorchidism (undescended testicle)
• Spermatic cord Thickening of the vas deferens may be due to chronic infection
A varicocele may also be felt along the length of the cord (only when standing) (Fig. 6.1)
Hydrocele (uid lled sac)
Spermatocele (retention cyst)
Tumour of testicle (hard, non-tender nodule)
Varicocele (enlargement of veins)
Normal
Fig. 6.1. Genitourinary examination.
