Urogenital: Examination (M)
Systemic Examination
  1. Environment, general appearance
  2. Hands, arms, face, neck, chest
  3. Abdomen, back, legs
  4. Urine
Genitalia Examination
  1. Penis
  2. Scrotum: insp, palp, translucency
  3. Spermatic cord

Systemic Examination

Environment
  • Dialysis tubes in flesh.
  • Dialysis bags.
  • Catheter.
General appearance
  • Hydration level: under (ARF).
  • Skin pigmentation (kidney excretion problems).
  • Hyperventilation (acidosis).
  • Hiccupping (uremia).
  • Twitching, spasms (hypocalcemia, N2 retention). 
Hands
  • Nails: leuconychia [white transverse bands], Muehrcke's nails [white paired lines near fingernail tip] (nephrotic syndrome's hypoalbuminemia).
  • Nails: others (do later).
  • Palmar creases: pallor (anemia).
  • Wrists: shunts from prior dialysis.
Arms
  • Scratch marks (2 hyperparathyroid).
  • Uremic frost [white powder on skin] (chronic renal failure).
  • Peripheral neuropathy (chronic renal failure 2 to diabetes).
  • Bone tenderness (low vit D).
  • Blood pressure (HTN 2 to chronic renal failure).
  • Postural hypotension if applicable (ARF).
Face, neck
  • Eyes: jaundice, anemia.
  • Eyes: fundi (diabetes). See Fundi Examination.
  • Mouth: fetor.
  • Mouth: ulcers, infections.
  • Face: rash (SLE, systemic sclerosis).
Chest
  • Heart: CHF.
  • Heart: hypertension.
  • Heart pericarditis.
  • Lung: pulmonary edema.
Abdomen
  • Scars: nephrectomy [may need to roll pt. on side], kidney transplant.
  • Distension (APKD/ Wilm's tumor [young], nephrotic syndrome, ascities, dialysis).
  • Palpate kidneys.
  • Palpate enlarged bladder.
  • Palpate hepatomegaly, splenomegaly (APKD).
  • Palpate AAA, so can DDx from renal stenosis on auscultation.
  • Assess ascites. See Ascites.
  • Percuss enlarged bladder.
  • Auscultate renal bruit: above umbilicus 2cm lateral to midline, then in flanks (renal artery stenosis).
Back
  • Ask if tenderness in back.
  • Sacral edema (CHF, nephrotic syndrome).
  • Gently strike base of spine with fist for tenderness (renal osteomalacia, 2 hyperparathyroidism).
  • Gently do Murphy's kidney punch in renal angle for tenderness (kidney infection).
Legs
  • Edema.
  • Peripheral vascular dz (chronic renal failure 2 to diabetes).
  • Injured toes from diabetes (chronic renal failure 2 to diabetes).
  • Purpura.
  • Toes: tophi (gout).
Urine

Genitalia Examination

Penis
  • Gloves on.
  • Retract foreskin if indicated.
  • Rashes, ulcerations, swellings, lesions, warts.
  • Urethral meatus:
    Meatus is patent
    Meatus is in normal location.
    No extra openings (hypospadias).
  • Look for discharge:
    Bloody.
    Purulent.
    Smegma [cheese-like substance] under foreskin.
  • If discharge, compress penis to excrete some into jar for analysis.
  • Tell pt. to cough (stress incontinence).
Scrotum: inspect
  • Pt. standing up.
  • Asymmetry is normal: L lower than R.
  • Note size (mumps), position.
  • Rashes, ulcerations, swellings, lesions.
  • Look for discharge:
    Bloody.
    Purulent.
  • Tell pt. to cough (stress incontinence).
Scrotum: palpate
  • Similar size, consistency for R and L.
  • Smoothness, firmness.
  • Absent testicle causes:
    Undescended [look in inguinal canal].
    Surgical removal.
  • Masses. See Testicular Masses Reference.
  • If mass palpated, Dr tries to get above it. If unable, likely an inguinal hernia.
Scrotum: translucency
  • Perform if a mass was palpated.
  • Turn off lights.
  • Hold light up to posterior of swelling, and test for translucency:
    Opaque: solid mass.
    Translucent: cystic.
  • Examine whether separate from the testis.
  • See Testicular Masses Reference.
Spermatic cord
  • Palpate from epididymis to superficial inguinal ring.
  • Locate both R and L ductus deferens within scrotum.