Physical Examination of the Genitourinary Tract
The history points; the examination confirms.
The big picture
The history points; the examination confirms. A focused genitourinary examination is quick, systematic, and remarkably high-yield — and a handful of physical signs change management on the spot. A hard nodule on the prostate, a scrotal mass you cannot get your fingers above, a varicocele that refuses to empty when the patient lies down — each of these turns a vague complaint into a clear next step. This is the bread and butter of the clinic and the heart of the urology OSCE.
The order: examine top to bottom — kidneys → bladder → external male genitalia (penis, scrotum, testis, epididymis) → female genitalia → digital rectal examination (prostate/rectum).
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Can't get above it → hernia; transilluminates → hydrocele; empties on lying down → varicocele. Keep the three manoeuvres straight.
A hard intratesticular mass is cancer — ultrasound it, don't observe.
A hard prostate nodule on DRE triggers a cancer workup regardless of PSA.
Do not vigorously massage an acutely inflamed prostate — risk of bacteraemia.
Always replace a retracted foreskin to avoid iatrogenic paraphimosis.
A new right-sided varicocele, or one that won't decompress, needs imaging for a renal/retroperitoneal cause.