Checklist
WIPER
• Patient standing. Trousers removed. Exposure from nipple to knee. Chaperone as required.
Physiological parameters
Inspection
• Scrotal asymmetry: pathology within hemiscrotum:
• absent testicle: failure of scrotal development or testicular descent, or orchidectomy
• scrotal mass
• Skin:
• oedema, cellulitis, Fournier's gangrene
• scars from previous scrotal surgery or orchidopexy
• Groin: scars (hernia repair) and masses (undescended testis)
Palpation
Patient standing:
Ask: ‘Do you have any pain?’
• Anatomy: define (a) superficial inguinal ring, (b) spermatic cord and vas deferens, (c) testicle, (d) epididymis. Compare left and right sides.
• Scrotal skin lumps: sebaceous cysts, abscesses and furuncles.
• Testicle: presence, contour, masses, size. If absent testicle, palpate groin and see if able to manipulate testicle into scrotum.
• Epididymis (posterior aspect of testis): tender or swollen.
• If scrotal mass felt:
• Can you get above it?
• Can you define testis and epididymis separately?
• Does the mass transilluminate (hydrocoele)?
• Is there a cough impulse (hernia/varicocoele)?
Patient supine:
• Re-examine the scrotum. Assess if any palpable abnormality becomes less prominent, as in the case of a varicocoele or hernia. Always ensure the scrotum is lifted up to inspect the posterior aspect of the scrotum and perineum.
To complete the examination…
• Examine the abdomen, especially if the testicle feels abnormal.
• Examine groin, penis and perineum: identify hernias, undescended or ectopic testes.