Chapter 18: Male Genitourinary Problems Assessment

Significant attention is given to the evaluation of hematuria, analyzing the timing of blood appearance—initial, terminal, or total—to localize lesions within the urethra, prostate, or kidneys. The physical examination section details specific techniques, including the assessment of Costovertebral Angle (CVA) tenderness for renal involvement, the inspection of external genitalia for phimosis or paraphimosis, and the critical Digital Rectal Examination (DRE) to grade prostate enlargement and detect nodules. Diagnostic differentiation of scrotal masses is emphasized using transillumination and palpation to distinguish between hydroceles, spermatoceles, and varicoceles (often described as a bag of worms), alongside the Prehn sign to differentiate the surgical emergency of testicular torsion from epididymitis. Laboratory and diagnostic protocols are reviewed extensively, including urinalysis interpretation for casts and nitrates, the Meares-Stamey 4-glass test versus the 2-glass premassage and postmassage test (PPMT) for localizing bacteria, and the use of Prostate-Specific Antigen (PSA) markers in the context of screening controversies. The chapter concludes by breaking down the differential diagnoses for common presentations, including the classification of prostatitis (acute bacterial, chronic bacterial, and chronic pelvic pain syndrome), the staging of Benign Prostatic Hyperplasia (BPH) using the American Urological Association (AUA) Symptom Index, and the identification of red flags for prostate, bladder, and renal cancers, such as painless hematuria or stony hard prostatic induration.