The diagnostic methods of evaluating infravesical obstruction, especially in BPH, are based on symptoms, history, digital rectal examination, intravenous pyelography, ultrasonography, uroflowmetry and residual urine, etc. But these methods cannot accurately and objectively evaluate infravesical obstruction. We measured voiding cystometry with uroflowmetry and urethral pressure profile in 24 BPH patients by Dantec UD5500. We classified the degree of obstruction into obstructive, equivocal and nonobstructive types by Griffiths' obstructive nomogram and Type 0 - VI by Schaefer's nomogram after computer assisted pressure-flow analysis. Among 24 patients, obstructive type was in 12, equivocal type in 6, and nonobstructive type in 6 by Griffiths' obstructive nomogram. Based on Schaefer's nomogram, type 0 was in 4 patients, type I in 6, type III in 4, type IV in 2, type V in 4 and type VI in 4. In our analyzed urodynamic parameters, Qmax, Pdet, Pmuo, Atheo and URA had statistical significance(p<0.05). We consider Griffiths' obstructive nomogram and Schaefer's nomogram based on pressure flow plot are objective methods of accurately evaluating infravesical obstruction.
Digital Rectal Examination ; Humans ; Nomograms ; Ultrasonography ; Urodynamics ; Urography

To define the practical value of prostatic needle biopsy in patients with suspicious prostatic carcinoma we studied the analysis of the clinical records of 49 patients underwent the prostatic needle biopsy at Severance Hospital during the 5 year period from 1976 through 1980. Forty-nine patients had been biopsied; carcinoma was found in 3 of 15 patients (20 per cent) not having prostatic induration, 6 of 17 (35 per cent) with minimal or equivocal induration and 12 of 17 (71 per cent) with marked induration. The results suggest that the vast majority of the patients with prostatic carcinoma has some degree of palpable induration and that a high index of suspicion appears warranted and needle biopsyshould be performed when any prostatic induration is present on digital rectal examination.
Biopsy, Needle* ; Diagnosis* ; Digital Rectal Examination ; Humans ; Needles* ; Prostatic Neoplasms

PURPOSE: Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis. METHODS: From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed. RESULTS: Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated. CONCLUSIONS: The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.
Anastomotic Leak ; Digital Rectal Examination ; Drainage ; Hand ; Humans ; Mortality ; Prognosis ; Rectal Neoplasms ; Retrospective Studies

PURPOSE: Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement. METHODS: We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated. RESULTS: The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities. CONCLUSION: The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer’s surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.
Colonoscopy ; Consensus ; Digital Rectal Examination ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Phenobarbital ; Rectal Neoplasms ; Rectum

Anal diseases are very common and it is important for a medical practitioner to understand how to deal with these diseases. To establish diagnoses of specific conditions, detailed history taking, inspection, palpation including digital rectal examination, and anoscopic examination are performed. Sigmoidoscopy is also required if upper lesions are suspected. History taking should include information about bleeding, prolapse, swelling, pain, discharge, irritation, bowel habit, continence, abdominal symptoms, weight loss. Sims' position and lithotomy position are commonly used for physical examination of the anal area. In addition to careful inspection and palpation, digital rectal examination should be performed to evaluate the anal canal width and sphincter strength. Above all, digital examination is a very useful and cheap tool to find rectal cancer which commonly occurs after middle-ages. Common anal diseases such as hemorrhoids, anal fissure, perianal abscess and fistula-in-ano, pruritus anai, and rectal prolapse are reviewed.
Abscess ; Anal Canal ; Diagnosis* ; Digital Rectal Examination ; Fissure in Ano ; Hemorrhage ; Hemorrhoids ; Palpation ; Physical Examination ; Prolapse ; Pruritus ; Rectal Neoplasms ; Rectal Prolapse ; Sigmoidoscopy ; Weight Loss

In order to define PSA levels by age decade in men without clinical evidence of prostatic adenocarcinoma, so called non-cancer, Tandem-R assay for PSA was performed in male patients older than 40 years who had visited to our department. We defined the non-cancer population as men with a normal PSA value( 4.0ng/ml or less) and negative digital rectal examination findings. Furthermore, patients with an abnormality in either PSA value or suspicious digital rectal examination underwent transrectal ultrasound and pathologically excluded prostatic cancer from the population by transrectal prostate biopsies or transurethral resection. A total of 203 men entered the protocol, of whom 192 satisfied our criteria of non-cancer population. New mean, standard deviation and cutoff serum PSA values by age proposed as mean + 2 standard deviations were derived as follows, 0.84 0.68ng/ml( 2.2ng/ml) in the 40 to 49-year group, 2.03 + 1.36ng/ml( 4.8ng/ml) in the 50 to 59-year group. 2.02 + 1.7lng/ml( 5.4ng/ ml) in the 60 to 69-year group, 3.16 + 1.91ng/ml( 7.0ng/ml) in the 70 to 79-year group and 4.52 + 4.03ng/ml(12.6ng/ml) in the 80 to 89-year group.
Adenocarcinoma ; Biopsy ; Digital Rectal Examination ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Ultrasonography

PURPOSE: We evaluated the diagnostic value of systematic sextant and lesion directed biopsy regimen in patients with hypoechoic lesions on transrectal ultrasonography (TRUS) for the detection of prostate cancer. MATERIALS AND METHODS: Between September 2003 and November 2005, a total of 142 men with sonomorphologic lesions suggestive of prostate cancer on TRUS underwent prostate biopsy. In all the subjects, lesion directed biopsies were taken in addition to the systematic 12 core biopsies. We examined the cancers detected in only the lateral region of 12 cores and the cancers detected in only the lesion directed biopsy, as well as the overall cancer detection rate. And, we compared the cancer detection rates of sextant and lesion directed biopsy, 12 core biopsy, and 12 core and lesion directed biopsy strategy. RESULTS: Of the 142 patients who underwent 12 core and lesion directed biopsy, 48 patients (33.8%) were diagnosed as having prostate cancer. The prostate cancer detection rate for systematic sextant and lesion directed biopsy and for 12 core biopsy was 28.9% (41/142) and 31.0% (44/142), respectively. There was no significant difference in the overall cancer detection rate between the three biopsy strategies (p=0.667). Also, when stratified by prostate-specific antigen (PSA) level, prostate volume, and digital rectal examination (DRE) findings, there was no significant difference in cancer detection rate between the three regimens. CONCLUSIONS: The systematic sextant and lesion directed biopsy strategy for patients with focal hypoechoic lesions on TRUS is an adequate and reasonable approach for the detection of prostate cancer with a relatively small number of biopsy cores.
Biopsy* ; Diagnosis ; Digital Rectal Examination ; Humans ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Ultrasonography*

We studied the efficacy of directed and random, transrectal sonographically guided biopsies in the diagnosis of prostatic carcinoma. Between January 1994 and June 1995, 33 men underwent transrectal sonographically guided biopsies of the prostate because they had clinical findings suggestive of prostatic carcinoma. Such findings included abnormal results on digital rectal examination and elevated levels of prostate-specific antigen. Of the 33 patients evaluated sonographically, 18 had hypoechoic lesions and 1S had no hypoechoic lesions. Of the 18 patients with a hypoechoic lesion, biopsy results were positive for carcinoma in 7 patients (35%). Of the 15 patients with no hypoechoic lesion, biopsy results were positive for carcinoma in 3 patients (20%). Of the 18 patients with a hypoechoic lesion, 16 had a hypoechoic lesion in the peripheral zone and 2 had a hypoechoic lesion in the transition zone. Of the 16 patients with a hypoechoic lesion in the peripheral zone, biopsy results were positive for carcinoma in 6 patients. Of the 2 patients with hypoechoic lesion in transition zone, biopsy results were positive for carcinoma in 1 patient. While 47% of patients with abnormal DRE findings and elevated PSA level had prostatic cancer, 13% of patients with biopsy-proved cancer had normal DRE findings and elevated PSA level. Of the 12 patients, 7 patients with biopsy-proved cancer had abnormal DRE findings, elevated PSA level and abnormal TRUS. The author conclude, therefore, that in` suspicious patients, sonographically guided transrectal biopsies of hypoechoic lesions may not be reliable as the sole method of detecting prostatic carcinoma. The yield of carcinoma detection increase significantly when random biopsies are performed in patients in which lesions are not found on transrectal sonograms. The optimal biopsy technique includes a transrectal sonographically guided core through any hypoechoic lesion in the nperipheral zone followed by bilateral segmental random biopsies.
Biopsy* ; Diagnosis* ; Digital Rectal Examination ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

PURPOSE: We designed the study to compare the efficacy of digital rectal examination(DRE), serum prostate specific antigen(PSA) & transrectal ultrasonography (TRUS) for the early detection of prostate cancer. MATERIALS AND METHODS: We analyzed the result of the prostate biopsies of 162 patients with abnormal hard nodule or asymmetricity on DRE, elevated serum PSA(> 4ng/ml) or hypoechoic lesion in peripheral zone on TRUS from August 1994 to June 1997. RESULTS: Of 162 patients, 26 patients(16%) had prostate cancer and 136 patients(84%) were diagnosed as benign prostatic hyperplasia. DRE, serum PSA and TRUS had sensitivities of 77%, 100% and 92%, respectively and positive predictive values(PPVs) of 48%, 26% and 19%, respectively. The sensitivities of high serum PSA(> 4ng/ml) with positive DRE, positive DRE with positive TRUS and high serum PSA with positive TRUS were 77%, 73% and 92%, respectively and the PPVs were 65%, 51% and 34%, respectively. In cases both DRE and TRUS were positive with high serum PSA, sensitivity and PPV were 73% and 68%, respectively CONCLUSIONS: The combination of DRE and serum PSA would be recommended as a first line examination in the diagnosis of prostate cancer regarding the sensitivity and PPV.
Biopsy ; Diagnosis ; Digital Rectal Examination* ; Humans ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms* ; Ultrasonography*

PURPOSE: To investigate whether the extended-core (eight- or ten-core) biopsy incorporating far lateral peripheral zone can increase the rate of prostate cancer detection compared to traditional sextant biopsy. MATERIALS AND METHODS: We retrospectively analyzed the results of prostate needle biopsies of 770 men with elevated serum prostate specific antigen (PSA) ranging from 4.1 to 20ng/ml. Ten-core, eight-core, and sextant biopsies were performed in 584, 111, and 75 men, respectively. There were no significant differences in age, mean level of serum PSA, prostate volume, and PSA density between extended biopsy group and sextant biopsy group. The cancer detection rate was compared between the two groups according to the range of PSA and finding of digital rectal examination (DRE). RESULTS: Overall cancer detection rate was 12.0% in sextant biopsy group and 18.3% in extended-core biopsy group (p>0.05). In men with abnormal DRE, there was no significant difference between the two groups in terms of the cancer detection rate (35.0% in sextant biopsy group versus 30.2% in extended biopsy group). However, significantly higher cancer detection rate was noted in extended-core biopsy group with normal findings of DRE (3.6% versus 12.7%). No significant difference of the cancer detection rate was observed between eight-core and ten-core biopsy groups. CONCLUSIONS: In men with an elevated PSA and a normal DRE, extended- core biopsy appears to enhance cancer detection compared to the traditional sextant biopsy, whereas sextant biopsy may be sufficient to detect the cancer in men with abnormal findings of DRE.
Biopsy* ; Biopsy, Needle ; Digital Rectal Examination ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies