General Examination
Ω Is the patient distressed due to pain or do they appear unwell suggesting systemic illness and possibly renal failure?
Ω Look for evidence of anemia.
Ω All patients with urological symptoms must have their blood pressure measured.
Ω Signs of dehydration such as a dry mouth and tongue may indicate renal failure or polyuria associated with diabetes.
Ω Lymphadenopathy; lymph nodes may be enlarged due to metastatic spread from any urological cancer.
Abdominal Examination
Ω Abdomen may be distended due to large polycystic kidneys or ascites due to nephritic syndrome or nephrotic syndrome. Palpate for an enlarged bladder or an abdominal aortic aneurysm.
Ω The kidneys are examined by bimanual examination with a hand posteriorly lifting up the kidney towards the examining abdominally placed hand.
Ω Tenderness over the kidney should be tested by gentle pressure over the renal angle.
Ω Palpation for renal enlargement or masses. An enlarged kidney usually bulges forwards. In polycystic kidney disease, there may also be hepatomegaly from hepatic cysts.
Ω Percussion for the presence of ascites (shifting dullness) and for an enlarged bladder.
Ω Auscultation for a renal bruit in renal artery stenosis (heard above umbilicus, 2cm to left or right of the midline and also in both flanks with the patient sitting up).
Scrotum and Genitalia
Ω Examine the foreskin to exclude a phimosis and signs of hypospadias.
Ω The testes should be equal in size, smooth and relatively firm.
Ω Absence of a testis may indicate previous excision, undescended or retractile.
Ω Small firm testes suggest hypogonadism or testicular atrophy.
Ω With the patient standing, if it is not possible to define the upper border of a mass in the scrotum then it is likely to be an inguinal hernia.
Ω Palpate the spermatic cord while the patient coughs for an impulse in a varicocele.
Ω If it is possible to define the upper border then the next step is to decide whether it is separate from or part of the testis.
Ω Testing for translucency with a torch will determine whether the mass is cystic or a solid mass. Likely diagnoses are:
θ Attached to the testis
∗ Solid (non-translucent)
∗ Cystic (translucent): hydrocele
θ Separate from the testis
∗ Solid (non-translucent) epididymal cyst
∗ Cystic (translucent): chronic epididymitis
Rectal Examination
Ω Is performed to palpate the prostate gland and identify any malignant changes in the gland.
Ω A hard lump in either or both lobes suggests a cancer and a biopsy is needed to obtain histological proof.
Ω Bimanual pelvic examination may be indicated in women.
Neurological Examination
Ω Dermatome sensory loss of the perineum or lower limbs and lower limb motor dysfunction suggest possible spinal cord or root pathology.
Ω Trauma or compression of the spinal cord may cause urinary retention if acute or urgency of micturition if a more chronic process.
Ω Acute compression of either the spinal cord or cauda equina may cause bladder and bowel dysfunction and are both neurosurgical emergencies, requiring urgent treatment to prevent irreversible neurological damage.
