China
Africa
Explore chapters and articles related to this topic
Questions 1–20
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
A 75- year- old man presents with new- onset back pain. He explains he has just started to experience pain in his back and ribs. Direct questioning reveals he is also suffering from urinary frequency and a poor flow. On digital rectal examination you find a hard prostate.
Prostate cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Jurgen J Fütterer, Fillip Kossov, Henkjan Huisman
The current diagnostic pathway in men with elevated serum PSA levels and/or abnormal digital rectal examination consists of a 12-core random standardized systematic transrectal ultrasound-guided prostate biopsy. Clinical staging of prostate cancer currently entails the use of digital rectal examination, PSA measurement, and transrectal biopsies. The clinical stage is identified using these variables and is expressed in the TNM staging classification (Table 17.1) (10,11). The Gleason score is a histopathologic score that correlates with prostate cancer prognosis. In order to determine optimal treatment, it is necessary to evaluate all patient and clinical characteristics.
Perianal Abscess
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Superficial abscesses present acutely as tender, localized, erythematous swellings, and some may present with discharge. Ischiorectal abscesses may take longer to become visible externally. They may present with vague pelvic or perianal pain and fever, and on examination, the buttock may be red and indurated compared with the unaffected side. Digital rectal examination can be painful in the acute setting and can be postponed until examination under anaesthesia, if appropriate.
Solitary fibrous tumors in prostate: a case report with review of the literature
Published in The Aging Male, 2022
Yueqiang Peng, Yu Jiang, Siwei Ding, Yongbo Zheng, Wei Tang, Jiayu Liu
However, the patient did not have any relief from his symptoms after the surgery, which lead to another hospital presentation. In our hospital, through digital rectal examination, we could find an enlarged prostate. US also showed enlargement of the prostate (46 mm × 35 mm × 28 mm) with uneven echo and no mass was detected. And residual urine was 60 ml. Maximum urinary flow rate (Qmax) was 6.3 ml/s (normal range, ≥15 ml/s). Therefore, his bladder outflow obstruction (BOO) was definite. Serum PSA level was normal (0.64 ng/ml; normal range, 0–4.0 ng/ml) while IPSS showed a severe symptom of 34 points. Accordingly, considering the patient’s age, the hyperplasia of the prostate found in the auxiliary examination, and the BOO of the patient, we were preliminarily more inclined to diagnose the patient for the small volume BPH. Generally, a patient aged 50 should not have such severe LUTs, and small volume prostate could also hardly cause these severe symptoms based on our experience. So, we suggested that he perform a magnetic resonance imaging (MRI) examination, but he refused because of personal reasons. We speculated that perhaps financial reasons or psychological reasons arising from prolonged and severe symptoms contributed to his rejection of the MRI examination. Therefore, A TURP was undertaken, and the patient’s symptoms were greatly relieved after the surgery. During the surgery, we also found that prostatic middle lobe and lateral lobe hyperplasia and did not find a high or tight bladder neck. Therefore, we were more convinced by our initial diagnosis of small volume BPH.
Short-term benefits of balneotherapy for patients with chronic pelvic pain: a pilot study in Korea
Published in Journal of Obstetrics and Gynaecology, 2020
Kyung-Jin Min, Hoon Choi, Bum Sik Tae, Min-Goo Lee, Sung-Jae Lee, Kwang Dae Hong
This was an open, prospective pilot study. Patients with CPP from outpatient clinics at Korea University Ansan Hospital were recruited between April and August of 2018. Enrolled patients were from three departments: Urology, Gynaecology and Colorectal Surgery. They gave a detailed medical history and underwent a physical examination. Participants received a different examination in each department according to their pain characteristics. Pelvic examination and pelvic sonography were performed on the patients who visited the Gynaecology Clinic. Digital rectal examination, rectal sonography and expressed prostatic secretions were performed on patients who visited the Urology Clinic. Digital rectal examination, sigmoidoscopy and anorectal sonography were performed on the patients who visited the Colorectal Surgery Clinic. Patients who needed additional tests after baseline examination received urine culture, thyroid hormone level, pelvic computed tomography, pelvic magnetic resonance imaging or total colonoscopy. Three specialists (HC, KJM and KDH) evaluated participants regarding the study criteria by holding an interdisciplinary case discussion every two weeks. Sixteen patients were enrolled and gave informed consent. Participants were allowed to take previously prescribed pain medications during the study period. The Institutional Review Board of Korea University Ansan Hospital approved this investigation (no. 2018AS0088).
Elobixibat, the first-in-class Ileal Bile Acid Transporter inhibitor, for the treatment of Chronic Idiopathic Constipation
Published in Expert Opinion on Pharmacotherapy, 2018
For a CIC patient, Idiopathic means that the Health Care Provider cannot identify a reason for the constipation. This clearly differs from the statement that there is no identifiable reason for the constipation. The section on Functional Constipation in Rome III presents a table of identifiable causes of constipation that contains 10 major headings with suggested pathways to the diagnosis and suggested treatment. Although the digital rectal examination (DRE) provides an opportunity to understand the neuromuscular integrity of the pelvic floor, the availability of the thoughtful and expert training necessary to obtain diagnostic DRE expertise is limited. Suggestions for additional diagnostic testing include defecography, full thickness intestinal biopsies, anorectal manometry and intestinal transit studies. Most practicing and academic physicians do not have access to some, or all, of these tests. By default, without the opportunity to confirm a specific diagnosis, the constipation becomes ‘idiopathic’. Many patients in whom a diagnosis could be made with sophisticated studies are being enrolled in CIC clinical trials. The noise created by the patients with causes of constipation outside of the accepted MOA of the investigated drug causes the small therapeutic difference between placebo and an investigated drug in all CIC clinical trials.