What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men

Abstract

BackgroundDigital rectal examination is an essential tool in the evaluation of the rectum. The aim of this trial was to determine the best position for performing a digital rectal examination. MethodsA total of 321 patients were randomized into “dorsal” or “lateral” groups in this multicentre randomized controlled trial performed in an outpatient setting. The primary endpoint was the proportion of patients with a complete digital rectal examination, defined as the examination of the rectum (upper border of the prostate), the entire circumference, and the assessment of the sphincter tone. ResultsThe dorsal group included a total of 161 patients (mean age: 62.3±13.04 years), while the lateral group included 160 patients (mean age: 62.7±14.4 years). The proportion of patients with a complete digital rectal examination was 44% (n=71) in the dorsal group and 49% (n=79) in the lateral group (p=0.3). The entire circumference of the rectum could be examined in 66% of the patients (n=106) in the dorsal group and in 79.5% of the patients (n=128) in the lateral group (p=0.007). ConclusionThe intergroup difference in terms of digital rectal examination completion rate was not significant. In the lateral position, however, the entire circumference of the rectum could be examined more thoroughly.