For years the significance of the so-called rectal toucher (rt) in relation to urinary ailments has been controversial. In this procedure the doctor puts a finger up the anus and feels the prostate and the mucous membrane of the rectum. The gravity of urinary complaints is rarely if ever related to the size of the prostate, whether this is assessed with the finger or by using ultrasound. In fact the size of the prostate is only of
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Urethra
importance to the urologist in deciding on the type of operation recommended, via the urethra or via an incision in the abdomen. Estimating the size of the prostate using rt depends undeniably on the experience of the person carrying out the examination. In general the size of a large prostate tends to be underestimated and that of a small one overestimated in rt. The assessment of consistency can provide an indication as to whether there is a benign enlargement, an inflammation or a cancer. The benign prostate has the consistency of the ball of a closed fist, cancer feels as hard as the joint between the metacarpals and the first phalanx bone in the hand, and in the case of inflammation the prostate feels as soft as the ball of the thumb with the fingers spread.
With rt the feelings of both the person examining and the patient are much more involved than in a general physical examination. It is not inconceivable that certain emotional reactions may lead to rt being skipped altogether. Research in the uk showed that with almost two — thirds of patients with urinary complaints gps omitted to carry out rt before referral. In addition it is well known that insufficient training of medical students leads to postponement and avoidance behaviour in later professional life. Nowadays, in many medical faculties there are systematic skills training courses in preparation for later practice. In a number of faculties specially trained instructors are used.