Physical Examination and Laboratory Tests

(1)

Functional Urology Unit, Casa Madre Fortunata Toniolo, Bologna, Italy

Physical examination in general should evaluate mental status, body mass index, mobility, physical dexterity, and abnormal gait. More specifically, it should be addressed to lower urinary tract and should be urodynamically oriented. A complete examination should include assessment of the abdomen, vaginal examination in females, rectal examination in males, and, in both sexes, focused neurological examination of sacral dermatomes (S1–S4) which are strictly related to lower tract function (Table 3.1).

Table 3.1

Physical examination

General
Mental status
Body mass index (BMI)
Mobility
Physical dexterity
Abnormal gait
Abdominal palpation
Male	Female
External genitalia	Vaginal examination
Digital rectal examination	Stress test for incontinence
	Urethral hypermobility
Focused neurological examination
Perineal sensation
Voluntary squeeze
Reflex activity
PFM testing

3.1 Abdominal Palpation

Lower abdomen should be palpated and percussed to demonstrate the bladder. In an adult, only a bladder containing 300 ml is likely to be palpated or percussed above the symphysis pubis. Sometimes the bladder may be difficult to palpate in spite of its content (the so-called “floppy” bladder). In these cases, pressing on the suprapubic region and asking the patient if he feels a need to void may be a good indication of a full bladder.

3.2 Vaginal Examination

Using a Sims vaginal speculum, anterior, posterior, and apical compartment should be systematically assessed. The degree of pelvic prolapse should be evaluated trough the pelvic organ prolapse quantification system (POP-Q). A cough test can be performed to look for stress urinary incontinence. Q-tip test may be used to assess urethral hypermobility.

Pelvic muscle tone and contraction strength should be manually assessed.

3.2.1 POP-Q (Fig. 3.1)

Fig. 3.1

POP-Q exam. The pelvic organ prolapse quantification (POP-Q) exam is used to quantify, describe, and stage pelvic support. There are six points measured at the vagina with respect to the hymen. Points above the hymen are negative numbers; points below the hymen are positive numbers. All measurements except tvl are measured at maximum Valsalva

Using the hymen as a fixed reference point, specific sites are defined in the anterior, posterior, and apical vaginal compartments and measured separately. These measurements are then categorized into a structured staging system (Fig. 3.2).