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EXAMINATION
The index finger sweeps over the prostate; the entire posterior
surface of the gland can be examined if the patient is in the proper
position.
o the prostate size is about a chestnut
o Consistency of the prostate is similar to that of the contracted thenar eminence
of the thumb (with the thumb opposed to the little finger)
The index finger is extended as far as possible into the rectum, the
entire circumference is examined to detect an early rectal carcinoma.
The index finger is then withdrawn gently, and the stool on the
glove is transferred to a guaiac-impregnated (hemoccult) card for
determination of occult blood.
Pelvic Examination in Female
Male urologists should always perform the female pelvic
examination with a female nurse or other health care
professional present.
The examination performed in standard lithotomy position with the
patients legs abducted.
The external genitalia and introitus should be examined for:
atrophic changes
erosions
ulcers
discharge
warts
all which may cause dysuria and pelvic discomfort
Pelvic Examination in Female,
cont.'s..
Inspection for the urethral Palpation of the urethra;
meatus; detect induration, which may be a sign of
caruncles chronic inflammation or malignancy
mucosal hyperplasia disclose a urethral diverticulum; palpation of a
cysts diverticulum may cause a purulent discharge
mucosal prolapse
Bimanual examination of the bladder,
The patient is asked to cough; uterus, and adnexa;
precipitate stress urinary
performed with two fingers in the vagina and
incontinence. the other hand on the lower abdomen. Any
Valsalva maneuver examined for; abnormality of the pelvic organs should be
cystocele (prolapse of the bladder) evaluated further with a pelvic ultrasound or
rectocele (prolapse of the rectum) CT scan.
Neurologic Examination
In some cases, the level of
neurologic abnormalities can be
localized by the pattern of
sensory deficit noted during
physical examination using a
dermatome map (Fig. 1-5).
Sensory deficits in the penis,
labia, scrotum, vagina, and
perianal area generally indicate
damage or injury to sacral roots
or nerves.
Neurologic Examination;
The bulbocavernosus reflex (BCR)
The bulbocavernosus reflex (BCR); a reflex
contraction of the striated muscle of the pelvic
flor that occurs in response to various stimuli in
the perineum or genitalia.
This reflex tested;
Placing a finger in the rectum
Squeezing the glans penis or clitoris.
For result; If the BCR is intact, tightening the anal sphincter should be
felt and/or observed.