Reis Leonardo Oliveira, Simão Antonio Felipe Leite, Baracat Jamal, Denardi Fernandes, Gugliotta Antonio
Faculty of Medical Sciences, University of Campinas, Unicamp, Rua Tessália Vieira de Camargo 126, Cidade Universitária "Zeferino Vaz", 13083-887 Campinas, SP, Brazil ; Faculty of Medicine, Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, 13060-904 Campinas, SP, Brazil.
Adv Urol. 2013;2013:797096. doi: 10.1155/2013/797096. Epub 2013 Sep 19.
Objectives. To standardize digital rectal examination (DRE) and set how it correlates with the comprehensive evaluation of lower urinary tract symptoms (LUTS). Methods. After scaled standardization of DRE based on fingertips graphical schema: 10 cubic centimeters-cc for each fingertip prostate surface area on DRE, four randomly selected senior medical students examined 48 male patients presenting with LUTS in an outpatient clinical setting, totaling 12 DRE each. Standardized DRE, international prostate symptom score (IPSS), serum PSA, transabdominal ultrasound (US), urodynamic evaluation, and postvoid residue were compared. Results. The mean and median PVs were US-45 and 34.7 cc (5.5 to 155) and DRE-39 and 37.5 cc (15 to 80). Comparing DRE and US by simple linear regression: US PV = 11.93 + 0.85 × (DRE PV); P = 0.0009. Among patients classified as nonobstructed, inconclusive, and obstructed, the US PVs were 29.8, 43.2, and 53.6 cc (P = 0.033), and DRE PVs were 20, 35, and 60 cc (P = 0.026), respectively. Conclusion. This is the first attempt to DRE standardization focusing on teaching-learning process, establishing a linear correlation of DRE and US PVs with only 12 examinations by inexperienced hands, satisfactorily validated in an outpatient clinical setting.
目的。规范直肠指诊（DRE）并确定其与下尿路症状（LUTS）综合评估的相关性。方法。基于指尖图形模式对DRE进行标准化缩放：直肠指诊时每个指尖前列腺表面积为10立方厘米（cc），四名随机挑选的高年级医学生在门诊临床环境中对48名出现LUTS的男性患者进行检查，每人共进行12次直肠指诊。比较标准化直肠指诊、国际前列腺症状评分（IPSS）、血清前列腺特异抗原（PSA）、经腹超声（US）、尿动力学评估和残余尿量。结果。经腹超声测量的平均和中位数残余尿量分别为45和34.7 cc（5.5至155），直肠指诊测量的分别为39和37.5 cc（15至80）。通过简单线性回归比较直肠指诊和经腹超声：经腹超声残余尿量 = 11.93 + 0.85 ×（直肠指诊残余尿量）；P = 0.0009。在分类为无梗阻、不确定和梗阻的患者中，经腹超声残余尿量分别为29.8、43.2和53.6 cc（P = 0.033），直肠指诊残余尿量分别为20、35和60 cc（P = 0.026）。结论。这是首次尝试在教学过程中对直肠指诊进行标准化，通过经验不足的人员仅进行12次检查就建立了直肠指诊与经腹超声残余尿量的线性相关性，并在门诊临床环境中得到了满意验证。
