Statement of Purpose
The genitourinary and rectal exam is an essential part of the overall health assessment in the male. A complete and efficient exam will lead to the identification of current or potential health problems. For a variety of reasons, novice providers may meet barriers that interfere with adequately learning to perform this exam. This educational module is meant to provide an illustrated way to learn the basics, and to begin to overcome reluctance to perform the exam when given the opportunity. In addition, when you believe in the importance of the exam and know that you can carry it out successfully, you will find that the patients and your supervisors will be willing partners in your learning.
While the discovery of abnormalities on exam is very important, the exam is a unique opportunity for the provider and the patient to communicate effectively about urinary and sexual function concerns, and how those concerns fit into the patient's overall health and well-being. When you and the patient work together during a well-executed exam, there is the development of mutual confidence and trust. That will lead to optimal health maintenance, and co-management of problems as they are identified.
The ultimate goal of this educational offering is for the learner to perform a male genitourinary and rectal exam with competence, given the appropriate setting and equipment to carry out the exam with efficiency. We want you to deliver a positive experience for the patient with minimal discomfort, and at the same time, to gain a good understanding of both the physical findings and genitourinary health status of the patient.
Over time and with repetition, you will become more skilled and comfortable with the exam. As you develop your own approach and best practice, feel free to modify the advice and direction given during this module to suit your own style and physical limitations. You each have different communication styles, arm and upper body strength, and length of examining fingers. Do the best you can when palpating the obese patient's abdomen, or reaching in as far as possible during the rectal exam, for example. Change your technique as needed, realizing that the end-goal is disease identification with the least amount of discomfort for the patient.
After completion of this online educational activity, the learner will be able to:
- Identify appropriate draping
- Recall correct order of exam
- Recognize order and process of abdominal exam
- Recognize correct hand placement flank exam
- Define skeletal landmarks, nodes, femoral pulses for inguinal/hernia exam
- Discuss all processes and techniques for exam of external genitalia
- Discuss best practices for positioning of fingers, hands, arms during rectal/prostate exam
- Select correct physical indicators for prostate cancer, other abnormalities on rectal/prostate exam
- Explain the position/approach to non-visible organs and structures
- Medical Students
- Physician Assistants
- Nurse Practitioners
- Male GU Exam – Opening
- Male GU Exam – Organizational Overview
- Male GU Exam – Statement of Purpose
- Abdominal Exam
- External Genital Exam
- Hernia Exam
- Inguinal Node Exam
- Rectal Exam
- Upright Exam
The Clinical Approach to the Patient
Morgan, W, and Engel, G., WB Saunders Co.
Philadelphia, PA 1969
Bedside Diagnostic Examination 3rd edition
DeGowin, E. and DeGowin, R.
Macmillan Publishing Co.
New York, NY 1976
The videography/production was done by David Rivaldo, University of Rochester
The illustrations were done by Jenny Smith, Dept of Medical Illustration, University of Rochester