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Renal Ballottement in Urological Exams

This document provides an outline and overview of the anatomy and physical examination skills relevant to urology. It discusses the anatomy of the scrotum and prostate, including vascular, lymphatic and nerve structures. Physical examination techniques are covered, such as assessing the scrotum for masses or tenderness, evaluating the vas deferens and cremasteric reflex, and using transillumination to differentiate fluid-filled from solid masses. The digital rectal exam is also summarized, highlighting aspects of the prostate and rectum to examine.

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amal.fathullah
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91 views13 pages

Renal Ballottement in Urological Exams

This document provides an outline and overview of the anatomy and physical examination skills relevant to urology. It discusses the anatomy of the scrotum and prostate, including vascular, lymphatic and nerve structures. Physical examination techniques are covered, such as assessing the scrotum for masses or tenderness, evaluating the vas deferens and cremasteric reflex, and using transillumination to differentiate fluid-filled from solid masses. The digital rectal exam is also summarized, highlighting aspects of the prostate and rectum to examine.

Uploaded by

amal.fathullah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Professional Skills

Urology Core Module


Trustin Domes

Outline
Brief Anatomy of Scrotum and Prostate
Physical Examination: CVA, Scrotum
and DRE
Case Scenarios
LUTS
Hematuria
Upper and lower urinary tract obstruction
Scrotal Masses/Pain

Anatomy of Scrotal
Contents
Vessels:
Testicle has 3 arterial blood
supplies:
Testicular artery
Cremasteric artery
Deferential artery

Pampiniform venous plexus

Lymphatics
Nerves
Cremasteric
muscle/fascia
Vas deferens

Anatomy of Scrotal
Contents
Vas is the most
posterior
component of
spermatic cord
Tunica vaginalis
surrounds the
anterior 2/3rd of
the testicle and
creates a
potential space
for hydroceles
and hematoceles

Clinical Anatomy of the Prostate

Verma S , Rajesh A AJR 2011;196:S1-S10

Prostate Anatomy
Peripheral Zone = 85% of prostate
cancer originate in this zone,
therefore are detected on DRE
Transition Zone = site of benign
prostatic hyperplasia

CVA and Ballottement


If CVA tenderness think:
- Renal colic
- Pyelonephritis
- Significant renal trauma
- Renal vascular occlusion

If you can ballot the kidney think:


- Large renal mass
- Polycystic kidney disease
- Severely hydronephrotic kidney

Physical Examination of the


Scrotum

Best to examine the man in both the supine


and upright positions
Helps to demonstrate conditions that change with
position: hernias and varicoceles

Bimanual examination of each testicle,


adenxa and spermatic cord
Testicular size, consistency, masses, tenderness
Normal testis size 16-20 cc (2 x 4 cm)

Examine cord upright (+/- valsalva) to assess for


presence of vas deferens, inguinal hernia and
varicocele

Cremasteric Reflex
Reflex elicited by stroking the medial thigh
causes an ipsilateral contraction of the
cremasteric muscle (bringing the testicle
closer to the external inguinal ring)
Reflex tests L1-L2 (genitofemoral nerve
responsible for afferent and efferent
limbs)
Typically absent in testicular torsion
Negative predictive value of over 90%

Transillumination
Important to
help differentiate
solid from fluidfilled masses
Hydroceles and
spermatoceles
will
transilluminate,
other scrotal
masses typically
WILL NOT

Hydrocele

Varicoceles
Dilated veins of the paminiform
plexus
Predominant left-sided (98%)
Isolated right-sided varicocele may
be caused by a retroperitoneal
NEED abdominal imaging
Varicocele grading:
Grade I: palpable only with
valsalva
Grade II: easily palpable without
valsalva
Grade III: large, visible through
scrotal skin

Grade III: bag of worms

Digital Rectal Examination


Comment on:
Prostate
Size
Symmetry
Consistency
Tenderness
Nodules
Rectal/Anal Masses
Rectal Tone

Prostate size
Average prostate size is
approximately 25 cc in men
25 cc
older than 50 years

150 cc

How many finger-bread


across?
Can you get to the top

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