2. Scrotal Disorders & Genital Examination
Dr Madaen

3. معاینه اسکروتوم هدف از این درس عبارتند از :
دانشجو با بیماریهای اسکروتوم آشنا شود .
دانشجو علائم و تشخیص های افتراقی بیماریهای ژنیتال را یاد بگیرد
با انواع بیماریهای مادرزادی ژنیتال آشنا شده بتواند راهنمائی لازم را در مورد پیگیری و درمان بموقع این بیماریها را بنماید.
با موارد اورژانسی بیماریهای ژنیتال آشنا شده و بتواند این موارد را بموقع تشخیص داده و ارجاع نماید.
دانشجو معاینه صحیح و کامل اسکروتوم را یاد بگیرد.
روش ارزیابی :
تئوری بیشتر بصورت MCQ
عملی بصورت استفاده از فرمهای Logbook

4. Physical Examination
Urologists have a unique position in medicine because their
patients encompass all age groups, including prenatal, pediatric,
adolescent, adult, and geriatric.
Because there is no medical
subspecialist with similar interests, the urologist has the ability to
make the initial evaluation and diagnosis and to provide medical
and surgical therapy for all diseases of the genitourinary (GU)
system.

5. HISTORY (Overview)
The medical history is the cornerstone of the evaluation of the
urologic patient, and a well-taken history will frequently elucidate
the probable diagnosis.
The patient may be
unable to describe or communicate symptoms because of anxiety,
language barrier, or educational background.
Therefore the urologist
must be a detective and lead the patient through detailed and
appropriate questioning to obtain accurate information.

7. Anatomy Canal Inguinal

8. Examination Check for any swelling:
Place the index and middle fingers of both hands under the
testicles with the thumbs placed on top
Check one testicle at the time with the unused hand placed
on the septum
Roll the testicle gently between the thumb and fingers- no
pain should be felt
Find the epididymis, the soft tube-like structure behind the
testicle
Clearly document the performance of the examination was
performed
Ensure further diagnostic or screening studies are carried
out if warranted

10. Inguinal hernia Exam

12. Findings: Normal findings- no lumps or bumps Abnormal :
Absence of Scrotom or hemiscrotom
Lumps or swelling on testes
Change in size or weight
Bulge or swelling in the scrotum
Other signs
• Dull abdominal or back pain

13. Absence

14. Ambiguous Genitalia

15. Genital organs : Scrotal:(testis and epididymis and cord)
Function of scrotum: cooler of testis, prevention for trauma, support of testis
Scrotum disease:
hydrocele ,hernia ,Undescended testis, varicocele ,Malignant masse & Inflammation
Hydrocele: trans illumination palpation, us

16. Male Genital Examination
Normal structures ,Size
Abnormal :
Hydrocel
Communicated
Simple
Cysts
Spermatocel
Hematocel
Varricocel
Solid masses
Inguinal hernia
Un-descended testis
Infections :Ori-Epididimitis

17. Scrotal Disorders :
Hernia: indirect hernia, upper port of cord cannot palpable, inguinal evaluation
Varicocele: anatomy of vein of testis left and right side different
Nut cracker phenomena, superior mesenteric artery, aorta, left renal vein
Oligoasthenospermia ,azoospermia,, slow hormone production,impotance and infertility
Leydic cell function

21. Varicocele Left side is more common Atrophy of testis Asthenospermia
Oligoasthenospermia
Nutcracker phenomena

25. Scrotal Warts

26. Penoscrotal transposition.

27. Buried penis

28. visualized by retraction of the skin lateral

29. Testicular Torsion Symptoms Age : 10-15
Etiology : Lock of gubernaculum

30. Testis Torsion

32. UDT=UNDESENDING TESTIS
UNPALPABLE TESTIS
Cancer ,atrophy and infertility

34. A, 5th week Testis begins its primary descent; kidney ascends.
B, 8th-9th weeks. Kidney reaches adult position.
C, 7th month, Testis at internal inguinal ring; gubernaculum (in inguinal fold) thickens and shortens.
D, Postnatal life.

37. A, Ectopic testes. Perineal ectopia not shown.
B, Undescended testes. Percentages of testes arrested at different stages of normal descent

38. Testis Tumor : Risk Factors Age: 20-35 highest group Cryptorchidism
Previous cancer in the other testicle
History of mumps orchitis, hydrocele or
inguinal hernia as a child
Smoking
Family history
Infertility (Irish Cancer Society 2006, p9)
Maternal hormone ingestion during
pregnancy (e.g. diethylstilbestrol)

39. Infection & Inflammations
Acute orchitis
Acute epidimitis
Chronic inflammations
Genital tuberculosis

40. Genital disorders

41. Acquired Genital Diseases
Meatal stenosis – Urethral stenosis
Balanitis
Balano- postitis
Dermatologic diseases

43. Meatal stenosis

44. Urine pooling caused by cicatricial scarring

45. Balanitis xerotica obliterans of the prepuce and meatus

46. Phimosis : caused by a preputial ring

47. Paraphimosis : with associated entrapped prepuce

48. Balano-postitis

49. Urine Rushes

50. Chancre

51. STD

52. Trapped penis by cicatricial scarring

53. Micropenis resulting from hypogonadotropic hypogonadism

54. Penile chordee and dorsal hood of foreskin without hypospadias

55. Penile torsion

56. ABNORMAL POSITION OF MEATUS:
POSITION AT VENTERAL OF PENIS (HYPOSPADIAS) IT MAY BE Coronal SUB CORONAL, MIDSHAFT PENOSCROTAL(it is possible for sexual differentiation disease)
POSITION AT DORSAL OF PENIS (EPISPADIAS)

58. Perineal Hypospadias

61. Extrophy Epispadias

62. Female Genital Congenital disease Masses Abnormalities
Ambiguous genitalia

63. Female Ureterocel