Examination of a patient

with prostate problem

Dr Vandana Krishna
General appearance and vitals
 Elderly
 Gait
 Vitals
HEENT/CVS/RESP
 Anemia in cancer, in renal failure (secondary
to chronic obstruction of the urinary tract)
 CVS/Resp – normal unless cancer spread or

due to renal failure which can result in

effusion
Abdomen
 Abdomen – check for hardness due to faeces
 Kidney – loin angle tenderness, enlarged

kidney (palpation/percussion)
 Bladder – check for enlargement, tenderness
 Back – vertebra – tenderness on palpation

(cancer spread)
Perineum
 Genitalia – any pus, trauma, infection/infmn
signs
 Prostate – through DRE – digital rectal

examination
Digital rectal examination
National cancer institute
DRE
Before examination:
 Introduce

 Explain the procedure to him, mention that it might be

uncomfortable but that it should not be painful, and obtain his

consent. He may also can have the urge to urinate during DRE
 Ask for a chaperone.

 Ensure privacy. Close curtains/doors properly before starting.

 Kindly inform that patient needs to lower his trousers and

underpants.
 Inform him that he will have to lie on his left side, to bring his

buttocks to the side of the couch, and to bring the top knee up
to his chest (Sims’ or left lateral recumbent position). There are
other positions as well that can be used.
 empty their bladder before DRE
Sims’ position
Other positions
1) left lateral with both legs flexed up to the
chest
2) modified lithotomy
Inspection
 Put on a pair of gloves.
 Gently separate the buttocks
 Inspect the anus and surrounding skin for

◦ Skin tags
◦ Redness
◦ Swelling
◦ Anything protruding from the anus
DRE procedure
 Lubricate the index finger of your right hand.
 Position the finger over the anus, as if

pointing to the genitalia.

 Ask the patient to relax and take deep breath

in and out
 Gently insert the finger into the anus,

through the anal canal, and into the rectum

Checking for
 Pain - any pain upon insertion.
 Anal tone - by asking the patient to squeeze

your finger (anal sphincter tone is of great

importance - a flaccid or spastic anal
sphincter suggests similar changes in the
urinary sphincter and may be a clue to the
diagnosis of neurogenic disease)
 Rectum - entire circumference for any

masses,
Checking for cont..
 Prostate (anterior rectal wall):
◦ size
◦ shape
◦ surface
◦ sensitivity
◦ symmetry
◦ consistency of the prostate gland in anterior rectal wall
◦ palpable midline groove
 Faeces - its consistency; colour of any stool,
and for the presence of any mucus or blood on
your gloved finger once you remove your hand.
After the examination
 Remove and dispose of the gloves. Clean off
any lubricant or faeces on the anus or anal
margin.
 Give the patient time to put his clothes back

on.
 Ensure that he is comfortable.
 Address any questions or concerns that he

may have.
Prostate examination findings
 Normal - size of a walnut, non-tender, feels firm
(similar to the consistency of the thenar eminence of a
hand closed in a tight fist with the thumb folded into
the palm), palpable median sulcus, 3cm in length
 BPH – feels firm (same as in normal) smooth, regular,
non-tender, enlarged
 Prostatitis – tender ++, size can be normal or slightly
enlarged, warm
 Prostate cancer – hard (consistency of the knuckle of
the thumb), irregular (discrete nodule, focal
induration, or a diffusely hard prostate), non-tender
Note
 Do not overlook the prostate gland when
searching for a source of sepsis in patients
with diabetes mellitus, patients on dialysis for
chronic renal failure, patients who are
immunocompromised, and postsurgical
patients who have had urethral
instrumentation.
 In all these settings, prostatitis can lead to

urosepsis