Examination and Investigation of The Urogenital System For GUU

Examination And Investigation
Of The Urogenital System

By
Dr Ngwu Paul E.
Learning Objectives
At the end of this lecture, the student should be able to:
1. Examine the different aspects of the urogenital system
2. Know the investigations that are indicated in common Urogenital
pathologies
3. Know the reasons for ordering any investigation in the management
of patients with urological and or Genital pathology.
Introduction
The Urogenital system comprises of those organs concerned with the

production and excretion of urine and those concerned with
reproduction. These are grouped together because of their proximity to
each other, their common embryological origin and the use of common
pathways, like the male urethra.
Relevant Anatomy
General Rules On Examination Of patients
• Wash hands
• Introduce yourself – name / role
• Confirm patient details – name / DOB
• Explain examination
• Gain consent :
“Do you understand everything I’ve said?“
“Are you happy for me to examine you?“
• Get a chaperone – this is absolutely essential
• Position the patient lying on an examination couch (you can ask the
patient to stand at the end of the examination)
• Don gloves
• Expose the patient
At The End Of Every Physical Examination
• Thank patient
• Allow patient time to get dressed
• Dispose of gloves
• Wash hands
Examination Of The Kidney
• In slim people with relaxed abdominal muscles it is sometimes
possible to feel a normal right kidney (the right kidney is situated
slightly lower than the left at the level of T12-L3). More often a
palpable kidney can only be felt because it is enlarged, as in
hydronephrosis, multiple cysts (polycystic kidney disease), or tumour
(generally unilateral).
• Rectal examination
Examination of the urinary bladder
• A distended bladder is identified in the lower abdomen by a
combination of palpation and percussion.
• Bimanual palpation of the bladder is a more reliable way of assessing
bladder enlargement than is simple per abdominal examination.
Bimanual palpation Of The Bladder in Males
Bimanual Palpation Of the Bladder in
Females
• Rectal examination also allows evaluation of the prostate gland, both
for benign enlargement and for the detection of malignant change
• Examination of the Uterus and ovaries under obstetrics and

gynaecology
Examination Of The External Genitalia
General Inspection
• Inspect the patient’s genital region and the surrounding areas (i.e.
penis / groin / lower abdomen):
• Skin changes – rash / bruising / swelling / erythema / hair loss
• Scars – especially in the inguinal region (hernia or orchidopexy)
• Obvious masses
• Inspect the scrotum from the front, sides and the posterior aspect by
lifting the scrotum.
• Inspect the perineum
Inspect the scrotum and perineum for:
• Skin changes – rash / ulcers / erythema (e.g. cellulitis / fungal
infection)
• Scars – may provide clues as to previous operations (e.g. vasectomy or
testicular fixation)
• Masses – note any obvious lumps, these will require examination later
• Swelling – unilateral or bilateral? / associated with erythema?
• Bruising
• Necrotic looking tissue
Palpation
Penis
• 1. Retract the foreskin to check for phimosis (narrowing of the foreskin)
or adhesions and describe any abnormalities on the glans
(ulcers/discharge/scarring)
• If you are unable to retract the foreskin, ask the patient to do this himself
• Be aware that a patient may be circumcised and comment on this to the
examiner
• 2. Open the urethral meatus to check patency.
• 3. Replace the foreskin once examined to prevent paraphimosis
Testes
• Examine each testicle individually.

• If abnormalities have been identified on inspection or the patient is
concerned about a particular testicle, start examination on the other
testicle.
• Ask the patient to report any pain or discomfort they experience
during the examination.
• . Use both thumbs and index fingers to gently palpate the whole
testicle.
• Your remaining fingers should be placed behind the testicle to
immobilise it
• 2. If you are unable to locate a testicle, palpate along the path of the
inguinal ligament for an undescended testicle (if the patient also has a
scar in their inguinal region this would suggest a previous
orchidectomy or orchidopexy).
If a mass is found, assess the following:
• Size / shape
• Regularity – regular vs irregular
• Consistency – hard (solid) / soft (cystic) / “Bag of worms” (varicocele)
• Discomfort – try to identify the specific area causing pain
• Are you able to get above the mass?- No = inguinal scrotal hernia
• Is the mass fixed to the testicle or separate?
• Separate + hard (solid) = epididymitis / orchitis
• Separate + cystic (soft / fluctuant) = epididymal cyst / spermatocele
•
• Is there a cough impulse? – presence of a cough impulse suggests
hernia
• Does the mass transilluminate?
Pelvic Examination And Examination of the
External Genitalia in females
• Pelvic examination better done in Lithotomy position
• Inspection of the vulva, vagina and the urethral meatus
• Speculum examination
• Possible lesions
Investigations Of The Urogenital System
• Urine based laboratory investigations
• Blood based laboratory investigations
• Radiological investigations
Urine based investigations
• Urinalysis
• Urine microscopy, culture and sensitivity
• Urine cytology
Blood based Laboratory Investigations
• Serum electrolyte, urea and creatinine
• Serum PSA
Radiological Investigations
• Plain abdominal Radiography
• Ultrasound scan
• Intravenous Urogram
• Retrograde Urethrogram and Micturiting Cystourethrogram
• Computed Tomography
• Magnetic resonance Imaging
Other Investigations
• Renal scintigraphy
• Urodynamic studies
• Urethrocystoscopy
Plain Abdominal Radiograph
The most common plain radiograph of the abdomen is an

anteroposterior (AP) view with the patient in supine position. The AP
view of the abdomen is also called by the acronym KUB film because it
includes the kidneys, ureters, and bladder.
Ultrasound Scan
• Renal: Visualization of renal tumors,renal cysts, nephrolithiasis,
hydronephrosis
• Bladder: Bladder wall thickness, bladder calculi, tumors
• Prostate: To estimate prostate volume, shape, echogenicity,
• Scrotal and penile: To evaluate for testicular
torsion, cryptorchidism, trauma, testicular tumors, varicocele,
and epididymitis
Intravenous Urogram
• An intravenous pyelogram, also called an intravenous urogram, is a
radiological procedure used to visualize abnormalities of the urinary
system, including the kidneys, ureters, and bladder.
• Indications:
• Assessment of patients with kidney stones
• visualization of renal excretion and the course of the ureters
Retrograde Urethrography
• A retrograde urethrogram (RUG) is a diagnostic procedure performed

most usually in male patients to diagnose urethral pathology such as
trauma to the urethra or urethral stricture.
Retrograde urethrogram
Micturiting Cystourethrography
• Micturiting cystourethrography is a technique for visualizing a

person's urethra and urinary bladder while the person urinates.
Computed Tomography Scan
Indications
• Investigation of choice to detect urinary calculi and renal masses
• Visualization of the urothelium in suspected malignancies and cases
of obstruction
• CT angiography helps evaluate acute pelvic trauma and tumor blood
supply, as well as diagnose renal vascular malformations
Magnetic Resonance Imaging
 Indications
• To differentiate between renal cysts and neoplasms.
• For accurate staging of bladder and prostate cancers
• As an alternative to contrast CT in patients who are allergic to iodine
based radiocontrast.

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Examination And Investigation

Of The Urogenital System

The Urogenital system comprises of those organs concerned with the

• Examination of the Uterus and ovaries under obstetrics and

• Examine each testicle individually.

The most common plain radiograph of the abdomen is an

• A retrograde urethrogram (RUG) is a diagnostic procedure performed

• Micturiting cystourethrography is a technique for visualizing a

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