Esclarecer o idoso sobre o exame digital retal diminui o desconforto na sua primeira realização? / Does clarifyng the digital rectal examination to the elderly reduce the discomfort in its first execution?

OBJETIVO: Verificar o grau de desconforto referido por homens idosos que realizam pela primeira vez o exame digital retal (EDR) na prevenção do câncer de próstata e o efeito de esclarecimentos prévios sobre essa queixa. MÉTODOS: Estudo prospectivo e aleatório em 120 homens, com idade de 60 a 80 anos, distribuídos em dois grupos: grupo A (consulta médica rotineira) e grupo B (consulta médica com intervenção educativa). No grupo B, os instrumentos de informação foram: palestra informal com esclarecimentos sobre EDR e câncer de próstata, visualização de maquete da pelve masculina, mostruário com as relações anatômicas prostáticas, simulador do EDR e DVD com animação tridimensional dos órgãos pélvicos. O grau de desconforto foi medido através da escala visual de dor. Utilizou-se o teste do qui-quadrado, com significância de 0,05. RESULTADOS: Houve diferença significativa entre o grau de desconforto referido no EDR entre os dois grupos, 81 por cento do grupo B referiram-no como leve e 80 por cento do grupo A, como moderado ou intenso, com p significativo de 0,01. Os sinais e sintomas foram a principal razão da consulta em 35 por cento dos pacientes, 78 por cento foram à consulta sozinhos e 81 por cento comentaram o exame com a parceira. Sem diferença estatística, 94,2 por cento no grupo A e 97,8 por cento no grupo B repetiriam o exame no ano seguinte e 91,6 por cento no grupo A e 96,6 por cento no grupo B relataram que o exame não foi pior do que imaginavam. Todos recomendariam o EDR para parentes ou amigos. CONCLUSÃO: Os pacientes que fizeram o EDR pela primeira vez após consulta urológica com esclarecimentos educativos prévios sobre o tema referiram significativamente menor desconforto.

OBJECTIVE: To assess the degree of discomfort reported by elderly men when first submitted to digital rectal examination (DRE) in the prevention of prostate cancer and the effect of previous explanations on this complaint. METHODS: A prospective, randomized study in 120 men aged 60 to 80 years, divided into two groups: group A (routine medical appointment) and group B (medical appointment with educational intervention). In group B, the information tools were informal talk with explanations of DRE and prostate cancer, visualization of model of the male pelvis and the anatomical relations with the prostate, DRE simulator and DVD with three-dimensional animation of the pelvic organs. The degree of discomfort was measured by visual scale of pain. We used the chi-square test, with significance at 0.05. RESULTS: There were significant differences between the degree of discomfort mentioned in DRE between the two groups; 81 percent of group B reported it as mild, while 80 percent of group A referred it as moderate or intense, with significant p=0.01. The signs and symptoms were the main reason for consultation in 35 percent of patients; 78 percent went to be consulted alone and 81 percent commented on their own examination with their spouses. With no statistical difference, 94.2 percent in group A and 97.8 percent in group B repeated the examination the following year and 91.6 percent in group A and 96.6 percent in group B reported that the exam was not worse than imagined. All would recommend DRE for relatives or friends. CONCLUSION: Patients who did the first DRE after urological consultation with prior educational clarification on the issue reported significantly less discomfort.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4 percent of Urologists, and left lateral position reported by 42.7 percent of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Effects of prostate manipulation on serum total and free prostate specific antigen, and free-to-total prostate specific antigen ratio

To evaluate the effects of the different types of manipulation on prostate total specific antigen [tPSA], free prostate specific antigen [fPSA], and free-to-total prostate specific antigen [f/tPSA]. A total of 160 males were enrolled from January 2006 to December 2009 in the Urology Department, Beijing Anzhen Hospital affiliated to the Capital Medical University, Beijing, China. Of these patients, 23 had digital rectal examination [DRE], 21 had urethral catheterization, 28 had rigid cystoscopy, 35 had prostate biopsy, 35 underwent transurethral resection of the prostate [TURP], and 18 underwent suprapubic prostatectomy. Blood samples were taken before, at 24 hours, and 4 weeks after the manipulation for PSA tests. The DRE had no significant effect on PSA. Catheterization and cystoscopy exerted significant increases in tPSA at 24 hours. However, these small increases may not be clinically significant. The fPSA and f/tPSA were not significantly changed. There was a marked increase in tPSA and fPSA, associated with a decrease in f/tPSA at 24 hours after biopsy. No significant alterations were found in tPSA, fPSA, and f/tPSA at 4 weeks after catheterization, cystoscopy, and biopsy. The TURP and prostatectomy caused significant increases in tPSA and fPSA at 24 hours, associated with decreases in f/tPSA. The tPSA and fPSA values were below the baseline levels at 4 weeks after TURP and prostatectomy, however, f/tPSA remained constant. The DRE, catheterization, and cystoscopy had no crucial effect on PSA. Prostatic biopsy, TURP and prostatectomy significantly affected the PSA levels, and their longitudinal courses should be considered while evaluating different forms of PSA levels

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9 percent). Before DRE, about 59.4 percent of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5 percent (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

OBJECTIVE: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS: DRE pain was related to both probe pain and biopsy pain. CONCLUSION: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.