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

Abstract

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% of Urologists, and left lateral position reported by 42.7% 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.

The eQuality Toolkit: Practical Skills for LGBTQ and DSD-Affected Patient Care

“…In practice, clinicians examining cis men usually perform digital rectal exams standing, although studies suggest that these patients actually prefer having the exam lying on their side. 112 Providers should use adequate lubricant, describe all steps of the procedure to the patient, and ask permission prior to proceeding.…”

Digital rectal examination in prostate cancer screening

“…The left lateral position has been show to be the least embarrassing without compromising the results of the test. 12 Furthermore, many patients view colonoscopy drastically differently than DRE. The reason is that colonoscopy is often perceived as more technological and hence perceived as more scientific.…”