21.How to examine male external genitalia Attention should be paid to the presence or absence of pubic hair and its distribution, the development of the penis, the presence or absence of deformity, prepuce or circumcision, the presence or absence of ulcers and swellings on the head of the penis or the coronal sulcus, the presence or absence of stenosis, inflammation and secretions on the external urethra, and the presence or absence of hard nodules on the corpus cavernosum of the penis. Pay attention to the size, shape, hardness, weight and the presence of pressure pain of both testicles; pay attention to the size of both epididymis, the presence of nodules, swellings and the head and body tail; pay attention to the presence of nodules and swellings of both spermatic cords and the presence of earthworm-like varicoceles; and pay attention to the condition of both vas deferens, pay attention to the thickness and the presence of nodules, etc. The actual prostate gland can be found to be enlarged, with a smooth and medium hard surface. The first degree of hyperplasia is an enlarged gland with a shallow central sulcus; the second degree of hyperplasia is a significantly enlarged gland with a disappearing or slightly protruding central sulcus; the third degree of hyperplasia is a significantly enlarged gland with a significantly protruding central sulcus, and even the upper edge of the gland cannot be touched by the fingers. It should be noted that even if the prostate is not large on rectal examination, the presence of hyperplasia cannot be denied. This is because when the middle lobe of the prostate is hyperplastic or the enlarged gland is protruding into the bladder, the finger may not be able to reach the enlarged gland, so other methods of examination are needed to confirm the diagnosis. The most common cause of prostate cancer is the hardening of the prostate gland, and the presence of hard nodules in one or both prostate lobes. Generally, 40% of those with abnormal fingerprints have prostate cancer. The positive rate of malignant tumors found on finger examination is 17% for mild prostate texture changes, 30-45% for significant texture changes, 40% for bilateral asymmetric prostate stiffness, and 30% for symmetric stiffness. In contrast, the changes in prostate enlargement are mainly an increase in size and a tougher texture, but are usually bilaterally symmetrical, with a shallow central sulcus that is still elastic. Other diseases that need to be differentiated from prostate cancer include prostate tuberculosis, stones, granulomatous inflammation, nodular hyperplasia, etc. 24.How to properly grade the spermatic veins Varicocele can be divided into three degrees through physical examination: degree 1 (mild): when standing, no varicose veins can be seen protruding from the scrotal skin, but varicose veins can be palpated in the scrotum, but the varicose veins disappear soon after lying down. Degree 2 (moderate): When standing, dilated veins can be seen on the scrotum and more obvious varicose veins can be palpated in the scrotum, but the varicose veins will disappear gradually when lying down. Degree 3 (severe): When standing, there are obvious thick blood vessels on the surface of the scrotum, and there are obvious worm-like dilated veins in the scrotum, and the walls of the veins are thickened and hardened; they disappear slowly after lying down. 25.How to properly examine intra-scrotal masses When conducting the examination of intra-scrotal masses, attention should be paid to the location, size, nature and activity of the masses. When the scrotum is swollen, the skin is thin, the cystic sensation and the transillumination test is positive, it is often a syringomyelia of the testis or spermatic cord. If earth-like swelling of the spermatic cord is found and disappears when lying down, it is varicocele. If the testis is enlarged, heavy feeling and sensation is reduced or disappeared, it is mostly a tumor. Swelling of the epididymis, pressure pain and thickening of the spermatic cord are mostly acute epididymitis. Swollen, hard, uneven or nodular epididymis is mostly epididymal tuberculosis. Small bulbous cystic swelling in the head of epididymis with positive transillumination test is mostly epididymal cyst.