The digital rectal exam (DRE) may be on track to be replaced by imaging devices. However, it is not only useful in prostate cancer diagnostics but also to feel anal carcinomas and other conditions.
In today's blog, I would like to take a look at a tried and tested method in urology, which is often threatened to be replaced by imaging devices. The digital rectal exam (DRE) has obviously lost some of its attractiveness in recent years. However, it is not only useful for prostate cancer diagnostics. Rather, it can also be used to find anal carcinomas and other conditions. The sense of touch alone requires a distinctive training, namely on living patients.
Anyone who does not use it every day will find it difficult to feel any irregularities, and patients have always been leaning towards avoiding this examination. But with sufficient training and practice, it can be a less discomforting experience, as a recent study by Australian scientists has shown. However, physicians have to practice on living people and not on the simulators that have widespread use in many places.
The hand of the expert physician, protected by a glove and with some lubricant, has always been an important diagnostic "instrument" for anal surfaces. But amongst colleagues, we hear often that, apart from urology or proctology, physicians have practically no sufficient experience with DRE to be able to recognize anything at all with any degree of certainty. And this palpatory skill is even more threatened amongst urology specialists as well, as a recent study from Australia revealed.
A team of urologists from Sydney, Australia, instructed a total of 48 prospective urologists in the digital rectal examination. At the end of a 30-minute introductory session, 26 participants were given the opportunity to practice with volunteers, while the rest gained their first practical experience in the DRE on a simulator.
As expected, the students who were allowed to practice on the human body had a greater increase in knowledge and felt much safer using the DRE. This proves once again that direct contact between physicians and patients has the greatest effect on diagnosis and treatment. However, the young physicians that had direct contact with patients in the training not only felt more competent but were actually more competent in the end than those who trained on the simulator.
Despite all efforts for more digitalization and the application of more medical equipment in imaging and diagnostics, the DRE on living humans should also have a firm place in future training curricula as a basic craft of urologists, and relevant specialties. In guidelines on prostate cancer, the DRE was recently only given recommendation level B for PCa diagnostics and should also be recommended, for example, in addition to the PSA test. However, the "feeling finger" of physicians in other fields of application, e.g. in the palpation of anal and rectal carcinomas, is still a first, inexpensive means of physical examination and should therefore not be completely forgotten in everyday practice. As is so often the case in life, practice makes perfect, and this is no exception.
Original study:
Patel MI et al. Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers. BJU Int 2019; https://doi.org/10.1111/bju.14778