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

PURPOSE: The relationship between morphological parameters of inflammation in prostatic tissue and the levels of serum prostate specific antigen (PSA) and prostate specific antigen density (PSAD) were investigated. MATERIALS AND METHODS: 95 prostate biopsies performed on 95 men with elevated serum PSA and/or abnormal digital rectal examinations of the prostate were reviewed. Of these, 42 malignant biopsies and 2 cases of clinical prostatitis were excluded. In the remaining 51 prostate biopsies, the extent of inflammation, aggressiveness of inflammation and presence of polymorphonuclear leukocytic infiltration were scored at both the acini and ducts. RESULTS: The mean serum PSA levels in grades 0, 1 and 2 for the extent of inflammation were 11.4, 8.5 and 9.3, respectively. The mean PSAD levels in these groups were 0.27, 0.17 and 0.17, respectively. The mean serum PSA levels in grades 0, 1 and 2 for the aggressiveness of inflammation were 9.2, 9.5 and 3.8, respectively. The mean PSAD levels in these groups were 0.19, 0.18 and 0.09, respectively. The mean serum PSA levels in the absence and presence of polymorphonuclear leukocytic infiltration were 8.8 and 9.13, respectively. The mean PSAD levels in these groups were 0.18 and 0.15, respectively. The mean serum PSA and PSAD levels were not significantly increased with the proportional increases in the morphological parameters of inflammation. CONCLUSIONS: The serum PSA and PSAD levels were found not to be significantly increased with proportional increases in the morphological parameters of inflammation in asymptomatic histological prostatitis. It is propose that asymptomatic inflammation in prostate tissue is not the reason for delayed repeat prostate biopsies.
Biopsy ; Biopsy, Needle* ; Digital Rectal Examination ; Humans ; Inflammation ; Male ; Needles* ; Prostate* ; Prostate-Specific Antigen* ; Prostatitis*

Transrectal ultrasonography is the most effective imaging method of prostate and it is known as an useful mean to detect and evaluate prostatic cancer. We performed transrectal ultrasonography for 200 patients with prostatism, 101 of which were diagnosed subsequently pathologically by prostatic biopsy or operation. Of 27 patients of sonographically suspicious prostatic cancer 10 were confirmed pathologically as cancer, and thered were another 4 patients with prostatic cancer which were classified to benign disease sonographically. The sensitivity and specificity of transrectal ultrasonography in diagnosis of prostatic cancer were 71.4 and 80.5 %. respectively, but the positive predictive value only 37%. The results do not seem that transrectal ultrasonography is superior to digital rectal examination in diagnosis of prostatic cancer. In identifying extracapsular extension of prostatic cancer, transrectal ultrasonography is thought to be potentially valuable, but further experiences are necessary.
Biopsy ; Diagnosis ; Digital Rectal Examination ; Humans ; Prostate ; Prostatic Neoplasms* ; Prostatism ; Sensitivity and Specificity ; 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

PURPOSE: A hypoechoic lesion is the most common finding of prostate cancer, but its diagnostic value is still an area of debate. The diagnostic significance of a hypoechoic lesion and the increased blood flow observed on transrectal ultrasonography (TRUS) were evaluated for the detection of prostate cancer. MATERIALS AND METHODS: The records of 266 patient's, between January 2003 and December 2005, were retrospectively reviewed. The cancer detection rates were compared according to the presence of a hypoechoic lesion in TRUS, and estimated with respect to stratification of the prostate- specific antigen (PSA) value and digital rectal examination (DRE) findings. RESULTS: The overall cancer detection rate was higher in the hypoechoic (40 of 101 cases, 39.6%) than in the isoechoic group (30 of 157 cases, 19.1%) (p<0.05). When the cases were divided into three groups, according to their PSA level (<4, 4-10 and >10), the cancer detection rate apparently increased in those with a hypoechoic lesion in TRUS (10.3 vs. 0%, 25 vs. 13.6% and 68.2 vs. 31% respectively) (p<0.001). Furthermore, the cancer detection rate was further increased in patients with a hypoechoic lesion than in those with an isoechoic lesion after division into two groups according to the presence of a hard nodule on DRE (with hard nodule, 56.9 vs. 46.7%; without hard nodule, 20 vs. 8.1%, respectively) (p<0.05). However, hypoechoic lesions with an increased blood flow did not improve the detection rate compared to those without (p>0.05). CONCLISIONS: The hypoechoic finding on TRUS not only supports the detection of prostate cancer, but also has independent diagnostic value. However, the findings of color Doppler are not helpful in the detection of prostate cancer.
Biopsy ; Digital Rectal Examination ; Humans ; Prostate* ; Prostatic Neoplasms* ; Retrospective Studies ; Ultrasonography*

PURPOSE: To investigate the relationship of transrectal ultrasound (TRUS) findings with the pathological characteristics of prostate cancer (PCa). MATERIALS AND METHODS: The study was conducted retrospectively by analyzing the data for 970 patients who underwent prostate biopsies. Gleason scores and other clinical variables were compared between PCa patients with and without hypoechoic lesions on TRUS. RESULTS: Of the 970 patients, PCa was diagnosed in 291 (30%). Of these, high-grade PCa (Gleason score of 7 or more) was diagnosed in 190 (65%). The cancer detection rate was higher in patients with hypoechoic lesions (43.9%) than in those without hypoechoic lesions (21.4%, p<0.001). High-grade PCa was detected more often in patients with hypoechoic lesions than in those without hypoechoic lesions (p<0.001). Independent predictors for high-grade PCa by logistic regression analysis included hypoechoic lesions on TRUS and abnormal digital rectal examination findings. CONCLUSIONS: Patients with PCa who had hypoechoic lesions on TRUS had more aggressive pathological disease than did those without lesions. Therefore, hypoechoic lesions on TRUS could be a marker for clinically significant PCa.
Biomarkers ; Biopsy ; Digital Rectal Examination ; Humans ; Logistic Models ; Passive Cutaneous Anaphylaxis ; Prostate ; Prostatic Neoplasms ; Retrospective Studies