Scrotal examination

 

Scrotum

Plan for examination of the scrotum
Scrotal neck Junction between corrugated & smooth skin

At root of penis

At the pubic tubercle

Skin
Tunica Normally not felt except there is fluid If Minimal fluid it is felt by benching

If large amount of fluid it is felt as swelling

Testis Testicular sensation

Size

Epididymis
Cord Thickness

Vas felt like tough structure

Inguinal region Inguinal lymph nodes (that drain scrotal skin)
Penis Shaft for Hypospadias

Epispadias

Circumcision
DRE Prostate

Seminal vesicles

Perineum
Abdomen Para-aortic lymph nodes

Maldescended testis

Neck Left  supraclavicular LNs ( Verchow’s sign)

 

Aim of examination in case of scrotal swelling is to answer 4 questions

Can you get above the swelling?

Can you identify the testis and the epididymis?

Is the swelling is translucent?

Is the swelling is tender?

and these are examples for how you can comment on your examination of scrotum.

Hydrocele

  1. “Enlarged right side of the scrotum”
  2. Look to back of the scrotum and penis
  3. “No signs of inflammation (scars, sinuses or dilated veins)”
  4. “No cough impulse and not reducible (بيرجع؟)”
  5. “I can get above the swelling so it is pure scrotal swelling”
  6. Feel the swelling (relation to testis and epidydimis)
  7. Transillumination

Varicocele

  1. Examine in supine position after standing
  2. Inspection normal
  3. Feel bag of worms
  4. May feel cough impulse or thrill
  5. Separate from testis
  6. Can get above it
  7. No transillumination

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