Couch or crouch? Examining the prostate: a randomized study comparing the knee-elbow and the left-lateral position

Area of Science:

• Urology
• Medical Examination Techniques

Background:

• Prostate examinations are crucial for diagnosing various urological conditions.
• The knee-elbow (KE) and left-lateral (LL) positions are commonly used methods for digital rectal examinations (DRE).
• Patient comfort and examination completeness are key considerations in DRE.

Purpose of the Study:

• To compare the completeness of prostate examinations using the KE and LL positions.
• To assess patient perceptions of pain and embarrassment associated with each examination method.
• To determine if one position offers a superior examination experience.

Main Methods:

• A comparative study involving 117 men undergoing prostate examinations at two urology clinics.
• Each participant received both KE and LL prostate examinations performed by the same clinician.
• The order of examination positions was randomized to minimize bias.

Main Results:

• The KE position allowed for a greater proportion of the prostate to be palpated in 35% of patients compared to LL.
• No significant difference in palpation completeness was observed in 60% of cases.
• Most patients reported similar levels of pain and embarrassment for both KE and LL positions.

Conclusions:

• The KE and LL positions are generally comparable for prostate examination completeness, pain, and embarrassment.
• The KE position serves as a valuable alternative for patients with difficult-to-palpate prostates or those experiencing pain during LL examination.
• Clinical choice between KE and LL may be guided by individual patient factors and palpation ease.