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GenitoGenito--Urinary ExaminationUrinary ExaminationRobert C. Robert C. FlaniganFlanigan, MD, MD

Albert J. Jr. and Claire R. Albert J. Jr. and Claire R. Speh Speh Professor and ChairpersonProfessor and Chairperson

Department of UrologyDepartment of UrologyLoyola University Medical CenterLoyola University Medical Center

StritchStritch School of MedicineSchool of Medicine

GU OrgansGU OrgansGU Organs� Internal

-Kidney- Ureter- Bladder- Prostate- Seminal vesicle- Vasal ampulla

� External- Penis- Testis- Epididymis- Vas deferens- Spermatic cord

�� InternalInternal--KidneyKidney-- UreterUreter-- BladderBladder-- ProstateProstate-- Seminal vesicleSeminal vesicle-- Vasal ampullaVasal ampulla

�� ExternalExternal-- PenisPenis-- TestisTestis-- EpididymisEpididymis-- Vas deferensVas deferens-- Spermatic cordSpermatic cord

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KidneyKidneyKidney� Palpable only in children and lean adults

� Enlargement- Hydronephrosis- Tumor- Perinephric pathology

� Renal pain- Palpate in CVA- Pyelonephritis- Urolithiasis

�� Palpable only in children and lean adultsPalpable only in children and lean adults

�� EnlargementEnlargement-- HydronephrosisHydronephrosis-- TumorTumor-- Perinephric Perinephric pathologypathology

�� Renal painRenal pain-- Palpate in CVAPalpate in CVA-- PyelonephritisPyelonephritis-- UrolithiasisUrolithiasis

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UreterUreterUreter� Impalpable except when massively dilated in children

� Traumatized by GSW and stabbing over a wide area of abdomen and back

� Best examined radiologically

�� Impalpable except when massively dilated in childrenImpalpable except when massively dilated in children

�� Traumatized by GSW and stabbing over a wide area of Traumatized by GSW and stabbing over a wide area of abdomen and backabdomen and back

�� Best examined Best examined radiologicallyradiologically

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BladderBladderBladder� Extraperitoneal organ in adults

� Palpable above pubis in midline

� Dull to percussion

� Compression elicits pain

� Distension- Urinary retention- Displacement

�� ExtraperitonealExtraperitoneal organ in adultsorgan in adults

�� Palpable above pubis in midlinePalpable above pubis in midline

�� Dull to percussion Dull to percussion

�� Compression elicits painCompression elicits pain

�� DistensionDistension-- Urinary retentionUrinary retention-- DisplacementDisplacement

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ProstateProstateProstate� Palpable by DRE

� “Chestnut-sized, squash ball consistency”

� Enlargement in 30’s

� Examination- Position- Landmarks- Prostate features

� Radiologic imaging

�� Palpable by DREPalpable by DRE

�� ““ChestnutChestnut--sized, squash ball consistencysized, squash ball consistency””

�� Enlargement in 30Enlargement in 30’’ss

�� ExaminationExamination-- PositionPosition-- LandmarksLandmarks-- Prostate featuresProstate features

�� Radiologic Radiologic imagingimaging

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Seminal VesicleSeminal VesicleSeminal Vesicle� Impalpable except in rare cases

� Lies postero-lateral to prostate

� Function

� Radiologic imaging

� Enlargement- Tumor- Ejaculatory duct obstruction

�� Impalpable except in rare casesImpalpable except in rare cases

�� Lies Lies posteropostero--lateral to prostatelateral to prostate

�� FunctionFunction

�� Radiologic Radiologic imagingimaging

�� EnlargementEnlargement-- TumorTumor-- Ejaculatory duct obstructionEjaculatory duct obstruction

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Vasal AmpullaVasal AmpullaVasal Ampulla� Impalpable except in rare cases

� Lies posterior to prostate either side of midline

�� Impalpable except in rare casesImpalpable except in rare cases

�� Lies posterior to prostate either side of midlineLies posterior to prostate either side of midline

PenisPenisPenis� Anatomy

� Abnormalities- Meatus- Prepuce- Skin- Erectile chambers

�� AnatomyAnatomy

�� AbnormalitiesAbnormalities-- MeatusMeatus-- PrepucePrepuce-- SkinSkin-- ErectileErectile chamberschambers

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TestisTestisTestis� Dimensions

� Consistency

� Enlargement- Testis versus entire hemiscrotum?- “Get above mass?”- Tenderness?

�� DimensionsDimensions

�� ConsistencyConsistency

�� EnlargementEnlargement-- Testis versus entire Testis versus entire hemiscrotumhemiscrotum??-- ““Get above mass?Get above mass?””-- Tenderness?Tenderness?

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Vas DeferensVas DeferensVas Deferens� Difficult to palpate except through practice

� Fibrous, mobile cord

� Presence vs absence

�� Difficult to palpate except through practiceDifficult to palpate except through practice

�� Fibrous, mobile cordFibrous, mobile cord

�� Presence Presence vs vs absenceabsence

EpididymisEpididymisEpididymis� Posterolateral to testis

� Anatomic parts

� Enlargement- Inflammation/infection- Tumor- Obstruction

�� Posterolateral Posterolateral to testisto testis

�� Anatomic partsAnatomic parts

�� EnlargementEnlargement-- Inflammation/infectionInflammation/infection-- TumorTumor-- ObstructionObstruction

Spermatic CordSpermatic CordSpermatic Cord� Varicose veins (Varicoceles)

� Lipoma

� Hernia

�� Varicose veins (Varicose veins (VaricocelesVaricoceles))

�� LipomaLipoma

�� HerniaHernia

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