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

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

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 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

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*

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