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Many diseases and medications can affect the urinary system and its function. Assessment of the male genitalia is accomplished with inspection and palpation. It is important to chart what is seen, what is felt, and what the patient reports.
The importance of a good physical examination cannot be underestimated. A good clinician must be able to differentiate normal from abnormal findings and should be familiar with both function (see Table 1) and location (see Table 2) of the organs involved. It may be as subtle as a mole that has changed slightly from last examination or as obvious as a new lesion that is draining.
Obtaining the History
Many diseases and medications can affect the urinary system and its function. The initial interaction with a patient should begin in a nonthreatening way, by reviewing his medical-surgical history and his current medications. A complete assessment of the male reproductive system includes a thorough review of the patient's history, since many conditions may present as complaints of pain to the reproductive structures. Pain from a kidney stone can radiate along the spermatic cord and present as testicular pain. Difficulty starting the urinary stream and complaints of perineal tenderness may indicate prostatitis or benign prostatic hypertrophy. Urethral pain can be a result of prostatitis, sexually transmitted diseases, or recent instrumentation. Urgency and frequency may be due to bladder dysfunction, a urinary tract infection, or treatment for low-grade bladder cancer. Complaints of a lump in the scrotum can be an inguinal hernia. It is always important to discuss and clarify the details of any previous genitourinary (GU) surgeries, particularly if they occurred during childhood. Details of any previous treatment for GU diseases or complaints should be discussed. Ask the patient whether he has been treated recently in an emergency department for the presenting problem or any other problem.
There are some conditions for which a physical examination is only modestly helpful. Erectile dysfunction cannot be seen or felt during a physical examination; therefore, this issue should be discussed with the patient. Ask about his relationship(s) and about his level of sexual satisfaction. If the patient has diabetes, hypertension, or depression and takes medication for these conditions, he may have erectile problems but may be too embarrassed to talk...