Digital Rectal Examination Standardization for Inexperienced Hands: Teaching Medical Students

Abstract

Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters—cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US—45 and 34.7 cc (5.5 to 155) and DRE—39 and 37.5 cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); P = 0.0009. Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6 cc (P = 0.033), and DRE PVs were 20, 35, and 60 cc (P = 0.026), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting.

Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading

“…Fingertip assessment was used by Reis et al, considering the area of prostate covered by one fingertip as 10 cubic meters. Thus for 4 fingertip impressions on the posterior surface of the prostate was inferred as 40 cc volume [18]. Romero et al, [3] documented a volume of 20 g for Grade I, 30 g for Grade I/II, 40 g for Grade II, 50 g for Grade II/III, 60 g for Grade III and 80 g or greater for Grade IV in their study.…”

European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculators significantly outperform the Prostate Cancer Prevention Trial (PCPT) 2.0 in the prediction of prostate cancer: a multi‐institutional study

“…If training is required to standardize estimations among urologists, a precedent has been set. In a 2013 study, Reis et al showed that the DRE could be standardized amongst a group of medical students and that DRE‐based volume correlated significantly with the TRUS prostate volume.…”

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

“…Patient evaluation: Patients were evaluated by history, International Prostatic Symptom Score (IPSS), Nocturnal Quality of Life Score (NQoL), general physical exam and systematized rectal examination (13), serum PSA, transabdominal prostate ultrasound evaluating intravesical prostatic protrusion (IPP), prostatic volume and post-micturition residue, and free uroflowmetry (Qmax) determined by one of the authors (OM). Patients were evaluated before the introduction of drugs in order to avoid bias.…”