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

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

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

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

Preoperative estimation of the volume of the prostatic gland is essential in making a decision whether to perform an open prostatectomy or a transurethral resection. But the shape of the prostate can not be revealed by X-ray because of its locational and anatomical characteristics. Several types of examinations, such as cystourethrography, cystoscopy, rectal palpation, are of value as descriptive macroscopic diagnostic methods but they can only indirectly procure representation of the prostate. Recently the anatomic structure of the prostate is visible in the form of an easily comprehensible cross sectional picture with ultrasonography and CT, which are new diagnostic, methods. Anatomical detail and cross-sectional format of ultrasonography and CT can clarify the boundary of the prostate and the relationship of the intrapelvic organs. Previously in our Department of Urology, Suprapubic ultrasonographic evaluation of the prostate had been reported and this time, we performed ultrasonography and CT simultaneously in 19 patients with BPH and 8 patients with prostatic carcinoma. And then the prostatic volume on the preoperative ultrasonographic and CT estimation were compared with the volume of the postoperative resected prostate. The following results were obtained: 1. There was no difference on the ultrasonographic and CT features of the prostate in the patients with BPH. BPH showed symmetric , round and oval shape, smooth margin and homogenous fine density within the prostate. Early prostatic carcinoma showed relatively asymmetric shape and inequal density Advanced carcinoma showed markedly irregular margin and infiltration to bladder wall and seminal vesicle. 2. The most part of the estimated prostatic volume was in 36.07-65.42 cc as 15 cases (55.6%) on ultrasonography and 16 cases (59.3%) on CT. 3. The mean prostatic volume of 19 patients with BPH was 4.44+/-0.47 cm (47 39+/-14.67 cc)- mean transverse diameter+/-standard deviation (mean volume+/-standard deviation) on ultrasonographic estimation and 4.63+/-0.46 cm (53.57+/-16. 12cc) on CT estimation. 4. The mean prostatic volume of 19 patients with prostatic carcinoma was 5.05+/-0.4 cm (68.64+/-15.1 cc) on ultrasonographic estimation and 4.96+/-0.35 cm (64.91+/-13.52 cc) on CT estimation, and it showed larger than that of 19 patients with BPH. 5. Through the comparative studies between the prostatic volume on the preoperative ultrasonographic and CT estimation and postoperative volume of the enoculated prostate, ultrasonographic estimation showed mean error rate 20.47+/-11.32%, correlation coeffcient 0.92(P<0.01) and CT estimation showed mean error rate 9.61+/-3.84%, correlation coeffcient 0.98(P<0.005). And so judging from the above result, CT was more accurate on preoperative estimation of the prostatic volume than ultrasonography.
Cystoscopy ; Digital Rectal Examination ; Humans ; Prostate ; Prostatectomy ; Seminal Vesicles ; Ultrasonography* ; Urinary Bladder ; Urology

PURPOSE: The systematic routine sextant biopsy technique has been widely used in diagnosing prostatic cancer. But this technique may not include an adequate sampling of the prostate. We conducted a prospective study to evaluate the efficacy of the routine sextant prostate biopsy plus selective lesion-directed prostate biopsy method. MATERIALS AND METHODS: 120 men with abnormal digital rectal examination (DRE) and/or prostate-specific antigen (PSA) > or = 4.0ng/ml underwent a total of 122 routine sextant prostate biopsy (RSB) only or RSB plus selective lesion-directed prostate biopsy (SLB). SLB included one of the followings: digital-guided biopsy, hypoechoic lesion-directed biopsy or transitional zone biopsy if there were palpable nodule on DRE, hypoechoic lesion on transrectal ultrasonography (TRUS), or previous history of negative biopsy, respectively. RESULTS: The mean age of patients was 67.6 years (43-86) and the mean PSA level was 7.63ng/ml (0.47-over 155). 37.7% had cancer detected on biopsy. Detection rate in RSB plus SLB group (53.6%, 30 of 56) was higher than in RSB group (24.2%, 16 of 66). In RSB plus SLB group, 4 had cancer detected in SLB core(s) only. The positive rate of biopsy core was higher in the SLB core (72.9% (35/48)) than in the RSB core (54.4% (98/180)) (p= 0.022). CONCLUSIONS: In the presence of a suspicious lesion or the history of a previously negative biopsy, the addition of SLB or transitional zone biopsy may increase the detection rate of prostatic cancer.
Biopsy* ; Digital Rectal Examination ; Humans ; Male ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Ultrasonography

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*