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: Most urologists, to our knowledge, recommend prostatic biopsy if serum prostate specific antigen(PSA) concentrations are between 4 and 10ng/ml(gray zone), even in the abscence of abnormal digital rectal examination(DRE). But the detection of prostate cancer has not been frequent in patients with negative DRE and gray zone of serum PSA. So, we investigated the detection rate of prostate cancer to evaluate the effectiveness of biopsy, and provide the clinical data which is needed to make an appropriate guideline for management in those patients in Korea. MATERIALS AND METHODS: We retrospectively reviewed 58 patients with negative DRE and serum PSA greater than 4ng/ml, in whom transrectal systemic biopsy was done between January 1, 1996 and July 31, 1998. Additionally we analysed 38 patients with negative DRE and serum PSA more than 4ng/ml in a Korean literature. We calculated the detection rate of prostate cancer in patients with gray zone of serum PSA and serum PSA greater than 10ng/ml, respectively. RESULTS: Prostate cancer was detected in 5 patients out of the 58 patients(8.6%), including 1 patient(3.7%) out of 27 patients with gray zone of serum PSA and 4(12.9%) out of 31 patients with serum PSA greater than 10ng/ml. Prostate cancer was detected in 4 patients out of the 38 patients in the literature(10.5%), including 1 patient(5.0%) out of 20 patients with gray zone of serum and 3 patients(16.7%) out of 18 patients with serum PSA greater than 10ng/ml. Combining the results of our current study with that of other Korean literature, total number of patients was 96, and 9(9.4%) of them proved to harbor prostate cancer, including 2 patients(4.3%) out of 47 patients with gray zone of serum PSA and 7 patients(14.3%) out of 49 patients with serum PSA greater than 10ng/ml. CONCLUSIONS: The detection rate of prostate cancer in Korean with negative DRE and gray zone of serum PSA is significantly lower than that in North American. Therefore it may not be effective to perform biopsy in all of those patients in Korea. Needed are Korean criteria of prostatic biopsy to detect prostate carcinoma in those patients, which can be acceptable in Korean.
Biopsy* ; Digital Rectal Examination* ; Humans ; Korea ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Retrospective Studies

Purpose: To determine the clinical differences between prostate cancer detected on initial biopsy and repeated biopsy Materials and Methods: Between January 2003 and December 2006, 67 patients were evaluated in this study who were diagnosed prostate cancer by transrectal ultrasound-guided biopsies and their prostate specific antigen (PSA) were below 20 ng/ml and clinical stages were less than T2. Among 67 patients, 43 patients were diagnosed at the first biopsies (group A) and others were diagnosed at the repeate biopsies (group B). We retrospectively characterized differences in clinical features such as age, digital rectal examination (DRE), prostate volume, the number of biopsy core, rate of positive core, PSA, % free PSA, Gleason score and rate of insignificant cancer. Results: There were no significant differences in age, PSA, % free PSA, rate of insignificant cancer between groups A and B. However, positive rate of DRE, prostate volume and rate of patients whose PSA were 7 ng/ml or higher in group A were significantly higher than those in group B. Despite the number of biopsy core was higher in group A, there were no differences in the number of positive biopsy core. Conclusions: Compared to the patients who were diagnosed as prostate cancer in the initial biopsies, prostate volume, positive rate of DRE and rate of Gleason score 7 or more were significantly lower in repeated biopsy group. From now on we are planning to include more patients and compare these characteristics of biopsies with the final pathological features after radical prostatectomy.
Biopsy ; Digital Rectal Examination ; Humans ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies

Purpose: The greatest concern in the androgen replacement therapy (ART) is the possible side effects to the prostate. We evaluated the effects of ART focusing on the prostate specific antigen (PSA). Materials and Methods: From 2003 to 2006, 47 patients 44 to 75 years old (mean age 60.1) received ART. At baseline and after ART, digital rectal examination, serum testosterone and PSA measurement and transrectal ultrasonography were evaluated. Mean follow-up was 7.9 months (range 1 to 41). Patients were classified into two groups based on the initial PSA level, as PSA levels of 2.5 ng/ml or greater (group 1) (n=29) and PSA levels of less than 2.5 ng/ml (group 2) (n=18). Results: ART significantly increased serum testosterone, PSA and free PSA levels. However, prostate volume did not change significantly. When serum PSA was compared, the increase of PSA levels was greater than in high PSA group (group 1) than in group 2, although the ratio between the two groups in PSA increase was 38.3% for group 2 and 18.2% for group 1, respectively. A total of 4 patients (16.7% of group 1 and 3.4% of group 2) with a serum PSA level greater than 4 ng/ml after ART underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusions: Rates of PSA elevation (>4 ng/ml) and prostate biopsies were higher in patients with high baseline PSA level (> or =2.5 ng/ml) than in those with PSA level less than 2.5 ng/ml who received ART. However, our findings suggest that an increased risk of prostate cancer was not associated with ART.
Biopsy ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Testosterone

PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.
Digital Rectal Examination ; Humans ; Incidence* ; Male ; Prostate ; Prostatic Hyperplasia ; Prostatism* ; Urinary Bladder ; Urodynamics

PURPOSE: Prostate-specific antigen(PSA) exist in serum in two major immunodetectable molecular forms: free PSA, and complexed PSA(PSA- alpha-1-antichymotrypsin). Total PSA represents the sum of the free and complexedorms. Preliminary investigations have illustrated the potential benefits of using percent free PSA to enhance the utility of PSA in distinguishing benign prostate disease from prostate cancer. Our study was undertaken to define the effectiveness of precent free PSA in the early detection of prostate cancer and to determine appropriate cutoff points for percent free PSA in Korea when total PSA level is normal or mildly elevated so as to eliminate negative biopsies. MATERIALS AND METHODS: Patient samples consisted of 24 histologically confirmed primary cancer, 83 men with untreated benign prostate disease histologically confirmed by negative sextant biopsies, and 29 men with normal digital rectal examination and PSA values less than 4.0ng/ml. Total PSA and free PSA levels were determined using PSA-RIACT and FPSA-RIACT kit(Cis Bio International, France), respectively. Percent free PSA was calculated for all patients. Within the range of 2.5-20.0ng/ml, receiver operating curve(ROC) was generated and utilized to evaluate cutpoints for percent free PSA to be used in clinical practice. RESULTS: When all subjects were included, both total PSA and percent free PSA significantly discriminated patients with prostate cancer from patients with benign histologic conditions(p=0.0003 and p=0.0001, respectively). However, in men with total PSA values between 2.5 and 20.0ng/ml, the percent free PSA significantly discriminated patients with prostate cancer from patients with benign conditions(p=0.001), whereas the total PSA did not(p=0.14). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the percent free PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. Within the range of 2.5-20.0ng/ml, the cutoff point for percent free PSA was 20. CONCLUSIONS: Measurement of percent free PSA enhance the ability to discriminate prostate cancer from benign histologic condition while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 2.5 and 20.0ng/ml.
Biopsy ; Digital Rectal Examination ; Humans ; Korea ; Male ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity