(临床诊断学) 仁济临床医学院诊断学教研室 An Introduction to Clinical Diagnostics



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Male Genitalia

The male genitalia include penis, scrotum, epididymis and seminal vesicle. The scrotum contains testes, epididymide, and spermatic cords. Inspection of the external genitalia (penis and scrotum) is followed by inspection of the internal genitalia (epididymis and seminal vesicle).
1.Penis

The normal size of penis in adult is about 7-10 cm, being conformed with 3 corpora cavernosa. The engorgement of the corpora, producing elongation and rigidity, is called erection. Various conditions that may alter this normal state of erection can be detected by careful inspection and palpation of even a flaccid organ.


1).Pretuce

The normal foreskin should be soft and pliable without breaks in continuity. If it is uncircumcised, it will be retracted and the urethral meatus can be found. At times retraction of the foreskin is difficult, and this condition, called phimosis, may require and incision to enable exposure of the glans penis. The causes of phimosis usually are adhesions of the prepuce to the underlying glans penis, inflammation, and congenital factors. When the foreskin is too long, but not infecting the exposure of the urethral meatus, it is termed prepuce redundant. The latter and Phimosis may be the pathogenic factors of penis infection or even cancer.


2).Glans penis and neck of penis

The glans penis and the neck of penis should be inspected throughly for its cdour, engorgement, excreta, edema, and nodular lesion. Finding a raised, firm, single, at times ulcerated lesion in the neck of penis may indicate chancre, which is important to the diagnosis of primary syphilis.

3). Urethral meatus

Swelling, excreta, and ulceration in urethral meatus opening may be the manifestation of urethritis infected by diplococcus gonorrhoeae or other organisms. The stricture of urethral meatus may be due to inflammatory adhesion or congenital deformation. Hypospadias can result in the ventral position of urethral meatus opening.

4).Size and conformation of penis

The size and conformation of penis may reflect the function of gonades. Too small in adult seen in patients with hypogonadism and too large in child seen in patients with proeotia are all abnormalities.


2.Scrotum

The scrotum is a musculocutaneous pouch that contains the testes, epididymides, and spermatic cords. It functions as a thermal regulator, keeping the testes one to two degrees cooler than normal body temperature. Its external appearance varies under different circumstances. The scrotum and its contents can be palpated with the patients in a standing or recumbent position.




  1. Spermatic cord

Spermatic cord is a flaccid structure with strip form. It contains vasa deferent, cremasteric muscle, arteries, veins, nerves of spermatic cord, and lymphatic vessels. Two spermatic cords are seen in left and right scrotal sac, respectively. Tenderness and swelling are seen in acute scrotitis, and beaded swelling in tuberculosis of spermatic cord. Infection, acute, subacute, or chronic, may involve the spermatic cord (funiculitis). Spermatocele and epididymal cysts are nontender, round masses palpable along the epididymis or cord.


  1. testis

Testis usually lies in the scrotum with its long axis in a vertical position. The normal testis may vary in size, shape, and consistency. These parameters should be examined carefully. Inflammation of the testis (orchitis) is rarely encountered in the absence of epididymal infection. Enlargement of the cord, epididymis, and testis may result from trauma. A tumor of the testis may appear as a painless, asymmetrically enlarged, firm, heavy, and sometimes nodular scrotal mass. Edema and redness seldom appear except as corollaries to inflammation and trauma.



  1. Epididymides

Along the posterior border of the testis is a ridge of tissue, called the epididymis, which is usually adherent and has about the same consistency as the testis itself. Nodularity of either the upper or lower pole indicates the presence of chronic infection or fibrosis. Epididymitis is the most common of all intrascrotal, inflammatory lesions in the adult male. Acute infection of the eididymis produces a firm, exquisitely tender enlargement of the entire epididymal body, swollen and reddened scrotal wall. Gonorrheal infections should be considered when there is an associated urethritis. In tuberculous epididymitis fistula may develop and the prostate, seminal vesicles, and vasa deferent are usually beaded or nodular.

Other abnormalities of scrotum are described as follows:



  1. edema of scrotum: may be the result of systemic or localized diseases. It can accompany chronic congestive heart failure, cirrhosis of the liver, and chronic nephritis.

  2. scrotium elephantiasis: massive scrotal swelling (elephantiasis) caused by lymphatic blockage with microfilaria occurs in tropical climates.

  3. Scrotal hernia: usually the condition of indirect inquinal hernia. The manifestation is often the enlargement of unilateral or bilateral scrotums, and descent to its normal scrotal position by cough or pushing.

  4. Effusion of tunica vaginalis: a common finding occurring in about 7.5% of all males. Diagnosis is usually simple because the scrotum is thin, smooth, and elastic and the cystic character of the hydrocele is easily appreciated on palpation. Light is readily transilluminated through a hydrocele, which can differentiate the hydrocele of tunica vaginalis from hernia and tumor.
  5. Scroti eczema: the characteristic presentation is great exudates, thickening of scrotal skin, small squama, erosion, and intractable itch.




  1. prostate

A careful evaluation of the prostate is an essential part of any physical examination in the male. The normal prostate in the adult is about the size and shape of a chestnut, and the location of the prostate gland is such that its posterior surface comes into close proximity with the rectum, so that it can be examined by touch when a finger is introduced into the rectum. Digital examination can be made with the patient standing beside the bed or examining table, leaning forward with hands on knees or lying on the bed in a knee-chest position. The gloved examining finger should be well lubricated and introduced gently into the anal orifice. Much more information can be obtained by performing this examination gently and tactfully. The first part of the urinary passage where it leaves the bladder channels directly through this gland in such a way that the lining of the urethra at this point is comprised of the exposed inner surface of the gland. This arrangement explains why enlargements of the prostate gland tend to encroach upon the urethral channel and cause obstruction to normal flow of urine. Enlargement of the prostate gland, and resulting interference with urination, occurs in about one third of elderly men. But the enlargement may not by directly proportional to degree of obstruction. The consistency of the prostatic tissue is usually firm and rubbery but may vary from a very soft, fluctuant texture that suggests prostatic abscess, soft carcinoma, or congestive prostatitis, to a stony hard nodularity that may involve small areas or the entire gland, usually suggesting granulomatous prostatitis, prostatic calculi, prostatic infarction, tuberculosis, or localized carcinoma. If any secretions are produced by prostatic palpation or massage, a specimen should be placed on a glass slide for microscopic examination to determine the presence of bacteria as well as cellular elements.
4. seminal vesicle

The seminal vesicles extend up laterally from the prostatic base beneath the bladder and usually are not palpable unless they are diseased. The abnomalities of the seminal vesicles are usually produced secondarily from the prostate diseases.





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