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Digital Rectal Examination of the Prostate and Rectum

Abbreviations: DRE (digital-rectal exam), PPA (palpatio per anum).

The physical examination is presented as a checklist with possible (pathological) results. Special important attention is given to important findings for urologists.

Digital rectal examination. Image from the National Cancer Institute.

Examination of the Anus

• Inspection: Hemorrhoids? Anal fissure?
• Palpation: tonicity of the anal sphincter? Anal sphincter reflex?

Examination of the Rectum

• Rectal tumor? Many of rectal cancer can be palpated.
• Blood on the glove? Hint for a lower gastrointestinal bleeding.
• Mobility of the rectal mucosa in relation to the prostate? Particularly in advanced prostate cancer, the mobility of the rectal mucosa is of value in assessing the operability before radical prostatectomy.

Prostate Exam

• Assessment of the prostate size
• Consistency of the prostate? Normal is a consistency like the contracted thenar muscle of the thumb. Prostate carcinomas are palpable as firm, indurated nodules (consistency like a knuckle of a finger).
• Tenderness? Sign of acute prostatitis.
• Fluctuations? Sign of a prostate abscess (with tenderness) or prostate cysts.

References

  Deutsche Version: Rektale Untersuchung von Prostata und Enddarm