Right Lateral Digital Rectal Examination in Men with Suspected Prostate Disease Presenting with Lower Urinary Tract Symptoms

Abstract

Background: The prostate gland is anterior to the rectum. There are different positions for digital rectal examination, and 95% of individuals are right-handed. This study aimed to determine the suitability and efficacy of right lateral digital rectal examination (RLDRE). Methods: A prospective cross-sectional study was conducted in a tertiary hospital on men with lower urinary tract symptoms due to benign prostate enlargement or prostate cancer. The perceptions of patients, surgical trainees, and medical students during RLDRE was assessed using the Likert scale questionnaire. The age and clinical presentation were documented. The ability to appreciate abnormal prostate disease was evaluated. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24 (IBM, Armonk, New York, USA). Pearson’s correlation coefficient for non-categorical variables was performed and the level of significance was p<0.001. Ethical approval was obtained. Results: A total of 203 patients were recruited, of which surgical trainees and medical students assessed 130 and 73 patients, respectively. The patients’ mean age was 69.5±9.1 years. The main presentations were urethral catheter in situ due to acute urinary retention in 77 patients (37.9%) and moderate lower urinary tract symptoms in 62 patients (30.5%). The number of patients with the RLDRE perception of well-tolerated, less awkward, and less painful were 161 (79.7%), 121 (59.9%), and 130 (64.4%), respectively. The perceptions of surgical trainees and medical students for ease of RLDRE were 77.7% and 74%, respectively, and for detection of abnormality were 57% and 68.5%, respectively. Detection rates for prostate cancer by surgical trainees and medical students were 87.5% and 75%, respectively, and for benign prostatic hyperplasia were 87.5% and 62.5%, respectively. Conclusion: RLDRE was well tolerated by patients. Surgical trainees and medical students were comfortable with RLDRE with reasonable detection of benign prostatic hyperplasia and prostate cancer.