Digital Rectal Examination Standardization for Inexperienced Hands: Teaching Medical Students

Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters—cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US—45 and 34.7？cc (5.5 to 155) and DRE—39 and 37.5？cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); . Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6？cc ( ), and DRE PVs were 20, 35, and 60？cc ( ), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting. 1. Introduction After anamnesis, clinical evaluation with physical examination is fundamental to proceed with patient investigation, determining the necessary complementary exams and even defining treatments. Classically, the initial approach to men presenting with low urinary tract symptoms (LUTS) is accomplished by digital rectal examination (DRE), prostate specific antigen (PSA), international prostatic symptom score (IPSS), and postvoid residue by ultrasonography (US) [1]. The DRE technique is a simple and well-established maneuver; however, this propaedeutic method and mainly its optimal quantification of prostate volume (PV) still remain empirical knowledge, with no scientific reasoning and standardization. PV has a direct correlation with natural history of prostate enlargement and subsequent risk of a poor outcome [1]. In this scenario, standardized, simple, fast, low cost, and effective methods for teaching inexperienced physicians on DRE ability are desirable, considering the recognized importance of DRE in terms of valuable information to direct patient treatment and the fact that this aspect of clinical examination is frequently relegated to the specialist [2]. At the expense of inefficient DRE, ultrasonographic parameters are the central method of assessing male LUTS [3], and it is not yet well established