From the Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, Missouri.
J Trauma Acute Care Surg. 2013 Nov;75(5):913-5. doi: 10.1097/TA.0b013e3182a68668.
The Advanced Trauma Life Support Manual (8th ed.) recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. A "high-riding" or "nonpalpable" prostate is a contraindication to urethral catheterization and an indication for urethrography. However, there are no published guidelines on, definitions of, or predictive values for high riding. Moreover, prostate evaluation can be difficult in the supine/trauma position.
A total of 100 patients underwent DRE in lateral decubitus position. Prostate size and distance from anal verge to the prostate apex were recorded. DRE in the supine position was then performed, noting the most proximal part of the prostate that was palpable. High-riding prostate was defined as the apex being one or more SDs farther from the anal verge than the mean. Fifty index finger lengths were measured to ensure that DRE findings were applicable to the average examiner.
A total of 100 prostates were evaluated. Mean (SD) distance from the anal verge to the prostate apex in patients with palpable prostates was 4.86 (1.38) cm (range, 2.5-8 cm). The prostate was nonpalpable in the decubitus position in 8 of the 100 patients and in the supine position in 42 of the 100 patients. Mean (SD) body mass index in the nonpalpable group was 32.6 (5.8) kg/m versus palpable group with 28.1 (5.7) kg/m (p < 0.01). Of the 100 patients, 26 had prostates that were "high riding" (defined as >6.2 cm from the anal verge), 2 of which were palpable in the supine position. Palpable prostates were closer to the anal verge at 4.13 cm compared with nonpalpable at 6.15 cm (p < 0.01). Mean (SD) index finger length is 7.3 (0.60) cm.
DRE in the pelvic fracture trauma setting to evaluate for urethral disruption is unreliable. Patients with a larger body mass index were less likely to have a palpable prostate. The use of the criteria of "nonpalpable" prostate has a high false-positive rate. Our objective definition of high-riding prostate should be incorporated into all trauma protocols.
Epidemiologic study, level V.
《高级创伤生命支持手册》（第 8 版）建议对所有创伤患者进行数字直肠检查（DRE）作为初始评估的一部分。“高位”或“不可触及”前列腺是尿道插管的禁忌症，也是尿道造影的指征。然而，目前还没有关于高位的发布指南、定义或预测值。此外，在仰卧/创伤体位时前列腺评估可能较为困难。
共有 100 例患者接受侧卧位 DRE。记录前列腺大小和距离肛门缘至前列腺顶点的距离。然后在仰卧位进行 DRE，记录可触及前列腺的最近端部分。高位前列腺定义为顶点距离肛门缘的距离比平均值多一个或多个标准差。测量了 50 个食指长度，以确保 DRE 结果适用于平均检查者。
共评估了 100 个前列腺。可触及前列腺患者的肛门缘至前列腺顶点的平均（SD）距离为 4.86（1.38）cm（范围，2.5-8cm）。100 例患者中有 8 例在侧卧位时前列腺不可触及，有 42 例在仰卧位时前列腺不可触及。不可触及组的平均（SD）体重指数为 32.6（5.8）kg/m，可触及组为 28.1（5.7）kg/m（p＜0.01）。100 例患者中，26 例前列腺“高位”（定义为距肛门缘＞6.2cm），其中 2 例在仰卧位时可触及。可触及前列腺距肛门缘更近，为 4.13cm，而不可触及前列腺为 6.15cm（p＜0.01）。平均（SD）食指长度为 7.3（0.60）cm。
在骨盆骨折创伤环境中进行 DRE 以评估尿道破裂是不可靠的。体重指数较大的患者更不可能触及前列腺。“不可触及”前列腺的使用具有较高的假阳性率。我们对高位前列腺的客观定义应纳入所有创伤方案。
流行病学研究，等级 V。
