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.