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      Digital Rectal Examination Standardization for Inexperienced Hands: Teaching Medical Students

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          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.

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          Most cited references 23

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          Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume.

          A filled bladder acts as an acoustic window for transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. The aim of this study is to evaluate the effects of bladder volume on transabdominal ultrasound measurements of these parameters. Twenty-two patients undergoing transurethral resection of the prostate (TURP) were studied. Under general anesthesia just before TURP, a transrectal ultrasound measurement of prostate volume was obtained. The bladder was then filled in a stepwise manner with 100, 200, 300, 400 and 500 mL. At each volume, the intravesical prostatic protrusion and prostatic volume were measured transabdominally using ultrasound. There was an obvious trend of decreasing mean transabdominal intravesical prostatic protrusions with increasing bladder volume. The mean transabdominal intravesical prostatic protrusion at bladder volumes 100, 200, 300, 400 and 500 mL was 9.1, 8.8, 7.4, 5.8 and 4.6 mm, respectively. The bladder volume at which maximum prostatic protrusion occurred was between 100 and 200 mL. The mean transabdominal prostate volume at the five increasing bladder volumes was 50.6, 48.7, 49.2, 47.9 and 41.4 mL, and these were correlated to transrectal prostate volume, particularly when the bladder volume was less than 400 mL. Transabdominal ultrasound measurement of prostatic protrusion is dependent on bladder volume. Transabdominal ultrasound measurement of prostatic volume correlates well with the transrectal measurement of the same parameter when the bladder volume is less than 400 mL.
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            Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction.

            Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. Forty-two patients, mean age 64.8 +/- 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8). IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.
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              Accuracy of prostate weight estimation by digital rectal examination versus transrectal ultrasonography.

              The ability to estimate prostate weight is useful. Two commonly used methods for estimating prostate weight are digital rectal examination (DRE) and transrectal ultrasonography (TRUS). We evaluated the relative accuracy of these weight estimates by comparing them to prostate weight following radical retropubic prostatectomy (RRP). Between 1989 and 2001 more than 36,000 community men participated in a large prostate cancer screening study. Of these men 2,238 underwent RRP. In this subset we examined the correlation between documented preoperative DRE and TRUS estimates of prostate weight with actual gland weight. DRE estimates of prostate weight by multiple examiners correlated poorly with RRP specimen weight (r = 0.2743). However, TRUS estimates correlated moderately well (r = 0.6493). TRUS provided more accurate estimates of prostate weight for smaller glands, although it generally underestimated gland weight compared to the weight of the surgical specimen. In a large, community based prostate cancer screening study prostate weight estimated by DRE was shown to correlate poorly with actual prostate weight. Compared with DRE, TRUS provides a better estimate of prostate weight. In addition, TRUS measurements were more accurate in smaller prostate glands.
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                Author and article information

                Journal
                Adv Urol
                Adv Urol
                AU
                Advances in Urology
                Hindawi Publishing Corporation
                1687-6369
                1687-6377
                2013
                19 September 2013
                : 2013
                Affiliations
                1Faculty of Medical Sciences, University of Campinas, Unicamp, Rua Tessália Vieira de Camargo 126, Cidade Universitária “Zeferino Vaz”, 13083-887 Campinas, SP, Brazil
                2Faculty of Medicine, Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, 13060-904 Campinas, SP, Brazil
                Author notes
                *Leonardo Oliveira Reis: reisleo@ 123456unicamp.br

                Academic Editor: William K. Oh

                Article
                10.1155/2013/797096
                3792526
                24170997
                Copyright © 2013 Leonardo Oliveira Reis et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Clinical Study

                Urology

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