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Digital Rectal Examination Periprocedural Care

  • Author: Adam Warren Ylitalo, DO; Chief Editor: Kurt E Roberts, MD  more...
 
Updated: Aug 12, 2015
 

Patient Preparation

Anesthesia

No anesthesia is needed, although in some patients, it may be easier to perform digital rectal examination concomitantly with other procedures that require general or intravenous sedation. Empirically, patients seem to tolerate procedures without anesthesia best when they are fully informed about expectations and are aware of exactly what is being done and when.

Positioning

Multiple positions may be used to accomplish a digital rectal examination. The easiest for the examiner is to have the patient tuck the knees up to the chest, either in the dorsal lithotomy position or the lateral recumbent position.

However, the traditional practice in the office-visit setting is to have the patient bend over a table at the waist with the knees slightly flexed, the feet shoulder-width apart, the toes pointed inward, the waist within inches of the table edge, and the forearms resting on the table. The patient should be made to feel as comfortable as possible; to this end, he or she should be afforded privacy and security in a relaxed environment.

 
 
Contributor Information and Disclosures
Author

Adam Warren Ylitalo, DO Resident Physician in Urological Surgery, Detroit Medical Center, Michigan State University College of Osteopathic Medicine

Adam Warren Ylitalo, DO is a member of the following medical societies: American College of Surgeons, American Medical Association, American Osteopathic Association, American Urological Association, Endourological Society, Michigan State Medical Society, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Acknowledgments

The authors wish to thank all of the great physicians who have taught and continue to teach the importance and clinical intricacies of the digital rectal examination.

Medscape Reference also thanks Adam Warren Ylitalo, DO, Resident Physician in Urological Surgery, Detroit Medical Center, Michigan State University College of Osteopathic Medicine, for assistance with the video contribution to this article.

References
  1. Roobol MJ, van Vugt HA, Loeb S, Zhu X, Bul M, Bangma CH, et al. Prediction of Prostate Cancer Risk: The Role of Prostate Volume and Digital Rectal Examination in the ERSPC Risk Calculators. Eur Urol. 2012 Mar. 61(3):577-83. [Medline].

  2. Ahmad S, Manecksha RP, Cullen IM, Flynn RJ, McDermott TE, Grainger R, et al. Estimation of clinically significant prostate volumes by digital rectal examination: a comparative prospective study. Can J Urol. 2011 Dec. 18(6):6025-30. [Medline].

  3. Barry, John. AUA Releases Statement Clarifying Prostate Cancer Testing Recommendations. Available at http://www.auanet.org/content/press/press_releases/article.cfm?articleNo=156. Accessed: April 13, 2011.

  4. Gerber GS, Brendler CB. Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis. Campbell-Walsh Urology, 9th ed. Available at http://www.campbellsurology.com. Accessed: April 13, 2011.

 
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A sagittal midline view of the male pelvic anatomy that may be examined with a digital rectal examination in relation to all surrounding structures.
Video of a digital rectal examination being performed on a patient in a left lateral decubitus position prior to prostate biopsy. Video courtesy of Adam Warren Ylitalo, DO.
Digital rectal examination. Drawing shows gloved and lubricated finger inserted into rectum to feel prostate. Image courtesy of National Cancer Institute.
 
 
 
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