Genitourinary System

Karon Sir, ang atong buhaton kay mag inspeksyon ta sa imong kinatawo. Ang atong
buhaton niana sir kay ato kining inspeksyonon, hikapon, ug paminawon. Pinaagi niini
mamahimo nato nga makit-an ang mga dili angay nga mga pag debelop sa atong kinatawo.
Kinahanglan kaayo nato Sir ang imung maayong pagsabot sa atong paga buhaton na aktibidad
para hapsay ug dire-diretsu ang atong pag buhat niini.

Inspection
1. Hair Distribution
 Note hair distribution pattern. “Atong lantawon sir
kung normal ra ba ang pagka distributar sa mga
buhok sa imung kinatawo.”
Normal: Pubic hair distribution triangular, sparsely
distributed on scrotum and inner thigh, and absent
on penis. Genital hair coarse. No nits or lice.
Abnormal: Sparse or absent hair (alopecia): May result
from genetic factors (developmental defects and
hereditary disorders), aging, or local or systemic
disease. Diseases include infection, neoplasms,
endocrine diseases, and nutritional or metabolic deficiencies. Other causes are
physical or chemical agents and destruction or damage to hair follicles.

2. Penis
 Note color, lesions, swelling, discharge, or pubic pediculosis on dorsal, lateral, and
ventral sides. “Ato usab lantawon sir ang color, mga samad, mga ginawsan sa imung
kinatawo, ug kung naa bay mga kuto sa imung kinatawo.”
 If uncircumcised, retract foreskin. Note ease of retraction of foreskin and inspect
glans. “Ug kung dili paka tuli sir, ato lang ipagawas ang tumoy sa imung kinatawo
sir para ma apil pud nato ug inspeksyon.”
Normal: No lesions or inflammation. Shaft skin loose and wrinkled without erection.
Glans smooth and free of lesions, swelling, or inflammation. No penile discharge.
Dorsal vein sometimes visible. If patient is uncircumcised, loose skin on the penis
shaft folds to cover glans, forming the foreskin. Foreskin retracts easily.
Abnormal:
 Chancre: Signals primary syphilis. Painless, ulcerated, exudative, papular lesion
with an erythematous halo, surrounding edema, and a friable base.
 Chancroid: Caused by Haemophilus through small breaks in epidermal tissue.
Pinhead papules to cauliflower-like groupings of painful, filiform, skin-colored,
pink, or red lesions.
 Condyloma acuminatum (genital warts): Caused by HPV infection. Multifocal,
wartlike, maculopapular lesions that are tan, brown, pink, violet, or white.
 Candida: Superficial mycotic infection of moist cutaneous sites. Erythematous
plaques with scaling, papular lesions with sharp margins and occasionally clear
centers and pustules.
 Herpetic lesion: Herpes simplex virus 1 and 2 cause painful eruptions of pustules
and vesicles that rupture. Fever, headache, dysuria, dyspareunia, and urinary
retention may occur.
 Tinea cruris: Fungal infection of the groin
often referred to as jock itch.
 Phimosis: Occurs in uncircumcised males.
Foreskin is unable to retract and may become
swollen.
 Priapism: Often associated with leukemia,
metastatic carcinoma, or sickling hemoglobinopathies.
 Chordee: Ventral or dorsal curvature of penis. Ventral chordee seen mostly with
epispadias.
3. Scrotum
 Note color, hair distribution, lesions, size, shape, and
position. “Lantawon nato ang color, pagka distribyutar sa
mga buhok, ang gidak-on, ang porma, ug ang posisyon sa
imung itlog, sir.”

Normal:
 Scrotal skin rugated, thin, and more deeply pigmented
than body color. Skin firmer in young men and
elongates with flaccidity in older men.
 Skin free of lesions, nodules, swelling, inflammation, and erythema. Scrotal size
and shape vary greatly. Left scrotal sac lower than right.
Abnormal:
 Masses: Can arise from benign or malignant conditions.
 Scrotal swelling: Seen with inguinal hernia, hydrocele, varicocele, spermatocele,
tumor, and edema.
 Hydrocele: Nontender accumulation of fluid between two layers of tunica
vaginalis in scrotum. May be idiopathic or a result of trauma, inguinal surgery,
epididymitis, or tumor. Mass transilluminates.
 Spermatocele: Nontender, well-defined cystic mass on superior testis or
epididymis caused by blockage of efferent ductules of rete testis.
 Varicocele: Varicose veins of spermatic cord that feel like a “bag of worms” and
slowly collapse when scrotum is elevated. Caused by dilated veins in
pampiniform plexus of spermatic cord. Right-sided may indicate obstruction at
vena cava.
 Sebaceous cyst: Round, firm, nontender cutaneous cyst confined to scrotal skin.
May result from decrease in localized circulation and closure of sebaceous glands
or ducts.
4. Urethral Meatus
 Note position of urinary meatus. “Lantawon nato sir kung unsa ang posisyon sa agi-
anan sa imung ihi.”
Normal: Located centrally on glans. Pink in white males and darker pink in darker-
skinned males. No discharge
Abnormal:
 Epispadias: Urethral meatus opens on dorsal (upper) side of penis.
 Hypospadias: Urethral meatus opens on ventral (under) side of penis.

5. Inguinal Area
 Note condition of skin, enlarged lymph nodes. “Atong
lantawon sir ang kondisyon sa panit sa imung
kinatawo ug kung naa bay pang hubag sa imung
bulog.”
 Have patient bear down and note any bulges. “Palihog
lang ta ug bilangkad gamay sir para makita nato kung
naa bay mga gagmay nga burot-burot sa imung
bulogan.”
Normal: No swelling or bulges. Lymph nodes nonpalpable.
Abnormal: Bulge may indicate a hernia or enlarged lymph node.

6. Rectal Area
 Note skin condition, lesions, rectal prolapsed, hemorrhoids, fissures, bleeding, or
discharge. “Atong lantawon sir ang condisyon sa panit, ang samad kung naa, mga
almuranas, mga pagdugo, ug mga gipang gawas na likido gikan sa imung lobot, sir.”
Normal: Skin intact with slightly darker pigmentation around anus. Anus intact; no
lesions; hemorrhoind, fissures, bleeding, or rectal prolapsed.
Abnormal: STD lesions, warts, hemorrhoids, fissures, bleeding, rectal prolapsed.
Palpation
1. Penis
 Lightly palpate shaft with thumb and index
finger. “Sir, ato lang hikapon ug hinay ang
tumoy sa imung kinatawo.”
 Note consistency, tenderness, masses, or nodules.
“Atong lantawon kung wala bay diperensiya,
sakit, ug mga bukol-bukol sa imong kinatawo.”
Normal: Pulsations on dorsal sides. Nontender. No
masses or firm plaques.
Abnormal:
 Diminished/absent palpable pulse: Possible vascular insufficiency.
 Normal blood flow may be affected by systemic disease, localized trauma, or
localized disease.
 Priapism is associated with spinal cord lesions or sickle cell anemia.
 Penis should not be enlarged in nonerect state.
 Phimosis and paraphimosis (foreskin retracts but does not return) are abnormal.

2. Urethral Meatus
 Note discharge. “Lantawon nato sir kung naa bay mga duga-duga nga dili normal sa
imung kinatawo.”
Normal: No discharge and drainage.
Abnormal:
 Purulent discharge or mucus shreds: Bacterial infection of GU tract. Color,
consistency, and amount may vary.
 Bacterial infection causes inflammation with leukocytes, shedding tissue cells,
and bacteria.

3. Scrotum
 Use thumb and two fingers to gently palpate scrotum, and note size, shape,
consistency, mobility, tenderness, masses, or nodules of testes. “Atong hikapon ang
 imung itlog sir para ma hibaw-an nato ang gidak-on, ang porma, ang gi parehason,
kung mu lihok ba, kung sakit ba, ug kung naa bay mga bukol-bukol.”
 Palpate the epididymis and vas deferens on posterolateral surface and note swelling or
nodules. “Atong hikapon kung naa bay pag hubag sa imong itlog or mga bukol-
bukol.”
 Transillumination: If a mass, lump, or swelling is present, shine light over area and
note transmission of light. “Kay naa may bukol imung itlgo, Sir, atong pasigaan ug
penlight sir aron mahayagan para makita kung unsa ka dako ang bukol.”

Normal:
 Scrotum contains a testicle and epididymis on each side.
 Testicles firm but not hard, oval, smooth, equal in size, and sensitive to pressure
but not tender.
 Epididymis comma-shaped, distinguishable from testicle, and insensitive to
pressure. Spermatic cord smooth and round.
Abnormal:
 A unilateral mass palpated within or about the testicle is abnormal. Intratesticular
masses are nodular and painless and should be considered malignant until proven
otherwise. (See section on inspecting the genitalia for description of spermatocele,
hydrocele, and varicocele.)
 Testicle that is enlarged, retracted, in a lateral position, and extremely sensitive:
Testicular torsion.
 Indurated, swollen, tender epididymis is abnormal.
 Undescended testes is abnormal.
  Cryptorchidism (absence of testes and epididymis in scrotal sac): Related to
testicular failure, deficient gonadotrophic stimulation, mechanical obstruction, or
gubernacular defects. The undescended testes have a histologic change by age 6,
so refer patient as early as possible.
 Orchitis is acute, painful swelling of testicle and warm scrotal skin. Patient may
feel heaviness in scrotum.
 Atrophic testicle and scrotal edema are abnormal.
 Red glow on transillumination: Serous fluid within scrotal sac. Occurs in
hydrocele and spermatocele.

4. Inguinal Area
 Horizontal lymph nodes: Palpate inguinal area. “Sir, atong hikapon imung bulog.”
 Vertical lymph nodes: Palpate inner aspect of thigh. “Sir, atong hikapon ang ubos sa
imong bulog.”
 Hernias: Place gloved index finger in scrotal sac above testicle and invaginate sac.
Follow spermatic cord to Hesselbach’s triangle, advance through external inguinal
ring, ask patient to bear down, and feel for bulges. “Sir, utong palihog kay atong
hikapon aron mahibaw-an nato kung naa ba kay mga bukol-bukol sa imong
bulogan.”

Normal:

 No red glow on transillumination.

  Nodes if palpable should be less than 1 cm and freely mobile. No bulges present
in inguinal area. No palpable masses in inguinal canal. No portions of the bowel
enter the scrotum. No palpable masses at femoral canal.
Abnormal:
 Unilateral or bilateral enlargement of inguinal lymph nodes: May indicate
bacterial infection. Nodes may be tender or painless. Lymph node enlargement
may also be associated with metastatic disease.
 Indirect inguinal hernia comes down inguinal canal and is palpated at inguinal
ring or in scrotum.
 Direct inguinal hernia is a mass that enlarges with coughing.
 Femoral hernia is palpated medial to femoral vessels and inferior to inguinal
ligament.

5. Rectum/Prostate
 If indicated, change gloves and apply water-soluble lubricant on index finger.
 “Sir, atong kuoton ang imong lobot para ma hibaw-an nato kung nay bay pagsakit,
mga bukol-bukol, mga ginatawag natong hemorrhoids, ug pag dugo sa imung lobot.
 “Sir, tung-tong lang ta diri sa exam table. Pag tung-tong nimu sir, palihug lang ta ug
utong sir inig ako nang i-sulod ang akong tudlo.
 “Sir, ato pud hikapon ang imung prostate aron mahibaw-an nato ang gi parehason
sa gidak-on ug ang porma niini. Ug usab sir, kini para mahibaw-an nato kung naa
bay mga bukol-bukol ug pagsakit sa imung prostate inig hikapon.
 Withdraw fingers; if stool present, test for occult blood.
Normal:
 Rectum smooth and nontender with good anal sphincter tone.
 Prostate small, smooth, mobile, and nontender.
 Medial sulcus palpable.
 Test stool for occult blood, negative.
Abnormal:
 Soft, nontender, enlarged prostate: BPH. Related to aging and presence of
dihydroxy-testosterone.
 Firm, tender, or fluctuant mass on prostate: Acute bacterial prostatitis. UTIs
commonly occur concurrently. Increased risk for prostatic abscess.
 Firm, hard, or indurated single or multiple nodules: Possible prostate cancer.
 Extremely tender, warm prostate: May indicate bacterial prostatitis. Do not
palpate vigorously. This would be painful and might cause bacteremia.
 Positive occult blood test warrants further evaluation.
 Palpable mass or nodule: Polyp or internal hemorrhoid.
 Hard mass: Possible rectal cancer.