Which physical exams should be performed in males who present with genitourinary complaints?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Males who present with genitourinary complaints warrant a thorough general physical examination, with particular attention to the vital signs, kidneys, bladder, prostate, and external genitalia.

Auscultation over the upper abdominal quadrants and the costovertebral angles may reveal the bruits of renal artery stenosis, an aneurysm, or an arteriovenous malformation. The costovertebral angles should also be percussed for tenderness. Palpation of the suprapubic area should be performed; a bladder that contains 500mL or more of fluid is often palpable as a suprapubic mass.

The external genitalia should be examined carefully. The penis should be examined for the presence of ulcers or lesions, and special attention should be paid to the urethral meatus for the presence of erythema or discharge. The testes and epididymis must be examined and palpated for tenderness and swelling.

A rectal examination with a 360° sweep of the interior of the rectum followed by careful palpation of the prostate can be performed. However, in patients with suspected acute bacterial prostatitis, palpation can be painful and may lead to bacteremia. Some authorities note that it is of little benefit in diagnosing acute prostatitis and state that prostatic massage should not be conducted in the setting of UTI or urethritis.


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