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

We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.
Biopsy ; Digital Rectal Examination* ; Humans ; Male ; Mass Screening ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Ultrasonography* ; Urologic Diseases

We evaluated the role of prostate specific antigen(PSA), digital rectal examination(DRE) and transrectal ultrasound(TRUS) in the diagnosis of prostate cancer. Of 93 patients with pathologically proven diagnosis, 19 patients had prostate cancer and 68 patients had BPH, while remaining 6 patients had other benign prostatic disease. Among the patients with prostate cancer, 17 patients had elevated PSA level(89%) and most of their PSA levels elevated above 10ng/ml(79%), while 2 patients with stage A disease had normal PSA level. Of 26 patients whose PSA levels were between 4 and 10microgram/ml, only 2 patients had prostate cancer(7.7%). However, these patients had significantly elevated PSA density compared to others. The positive predictive value of PSA, DRE and TRUS was 27%, 44% and 40% respectively. DRE and TRUS had 56% and 58% positive predictive value in patients with elevated PSA level in contrast to 0% positive predictive value of DRE and TRUS in patients with normal PSA level. When all three methods were combined, the positive predictive value rose to 67%. Although positive predictive value of DRE and TRUS was 44 and 40 % respectively, these methods appeared to be valuable when PSA level elevated concomitantly. Our data suggest that prostate biopsy should be performed in patients with elevated PSA level above 10ng/ml and PSA density might be valuable in patients with marginal PSA level (4-10ng/ml).
Biopsy ; Diagnosis* ; Digital Rectal Examination* ; Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Diseases ; Prostatic Neoplasms* ; Ultrasonography*

We measured the concentration of serum PSA to define statistical upper limits for PSA in relation to age in 228 men without clinical evidence of prostatic cancer. We defined the cancer-free group as men with a PSA less than or equal to 2.5ng/ml(ELSA-PSA' monoclonal immunoradiometric assay) and nonsuspicious digital rectal examination and those with an abnormality in either parameter underwent transrectal ultrasound and pathologically excluded prostatic cancer from the group by transrectal prostatic biopsy or transurethral resection. A total 252 men between 40 and 79 years of age entered the protocol, of whom 228 men satisfied our cancer-free criteria. There was a significant correlation between natural logarithm transformed PSA(In PSA) and age by linear regression analysis(r=0.32, p=0.02) and age-specific upper limits of PSA=mean+2SD) were 2.62ng/ml in the 40 to 49-year group, 3.45ng/ml in the 50 to 59-year group, 5.09ng/ml in 60 to 69- year group and 7.07ng/ml in the 70 to 79-year group.
Biopsy ; Digital Rectal Examination ; Humans ; Linear Models ; Male ; Prostatic Neoplasms ; Ultrasonography

The serum PSA concentration is directly correlated with patient age and prostatic volume. Thus, rather than rely on a single reference range for men of all age group, it is more appropriate to have age-specific reference ranges. We define the cancer-free population as men with a PSA less than or equal to 4.0ng/ml and nonsuspicious digital rectal examination, and those with an abnormality in either parameter with a nonmalignant prostate biopsy. A total of 905 men was recruited for a prostate cancer detection study using serum PSA and digital rectal examination, of whom 869 fulfilled our criteria of cancer-free. The upper limits for PSA(mean +2 standard deviations) by age were 2.89ng/ml in the 40 to 49-year group, 4. 67ng/ml in the 50 to 59-year group, 5.49ng/ml in the 60 to 69-year group and 6.48ng/ml in the 70 to 79-year group. It is the purpose of our study to know that how accurate our definition of normal as evidenced by a lack of cancer in men with a normal digital rectal examination and PSA between 4.0 and the derived upper limit of normal is. The apparent accuracy of these new limits is strong in the 50 to 69-year group but it declines in the next decade. The data support further attempts at using PSA, age and digital rectal examination to establish selection criteria for prostate biopsy with adequate specificity.
Biopsy ; Digital Rectal Examination ; Humans ; Male ; Patient Selection ; Prostate ; Prostatic Neoplasms ; Reference Values* ; Sensitivity and Specificity

We report the case of a rectal teratoma. A 62-year-old woman was referred to our department for evaluation of a rectal mass. She had a 3-month history of rectal bleeding and constipation. No palpable mass was detected using digital rectal examination. Colonoscopic examination demonstrated a protruding mass with a broad stalk in the posterior wall about 12 cm from the anal verge. A computed tomography scan showed a mass, which contained calcifications and fatty components, protruding into the rectal lumen. On operation, the mass was located in the upper rectum, and the right lateral portion of the upper rectum was adhesed to the right ovary. Thus, she had undergone a low anterior resection and right oophorectomy. The pathologic results confirmed a teratoma arising in the muscularis mucosa and the submucosa of the rectal wall.
Constipation ; Digital Rectal Examination ; Female ; Hemorrhage ; Humans ; Middle Aged ; Mucous Membrane ; Ovariectomy ; Ovary ; Rectum ; Teratoma*