Quality statement 1: Initial assessment – physical examination

Quality statement

Men with lower urinary tract symptoms (LUTS) are offered a full physical examination, including a digital rectal examination, as part of their initial assessment.

Rationale

It is important to carry out a full physical examination so that abnormalities of the abdomen and external genitalia are not missed and left untreated. Performing a digital rectal examination is essential to assess the size of the prostate and to detect abnormalities that might indicate malignancy. It is also good practice to identify abnormalities, such as prostatitis (inflammation of the prostate) and associated conditions, which might affect bladder function.

Quality measures

Structure

Evidence of local arrangements to ensure that men with LUTS are offered a full physical examination, including a digital rectal examination, as part of their initial assessment.

Data source: Local data collection.

Process

Proportion of men with LUTS who receive a full physical examination, including a digital rectal examination, as part of their initial assessment.

Numerator – the number of men in the denominator who receive a full physical examination, including a digital rectal examination, as part of their initial assessment.

Denominator – the number of men who present with LUTS.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that systems are in place to provide a full physical examination, including a digital rectal examination, for men with LUTS, as part of their initial assessment.

Healthcare professionals ensure that they offer men with LUTS a full physical examination, including a digital rectal examination, as part of their initial assessment.

Commissioners ensure that they commission services with local arrangements to offer men with LUTS a full physical examination, including a digital rectal examination, as part of their initial assessment.

What the quality statement means for patients, service users and carers

Men with LUTS are offered a full physical examination, which includes the healthcare professional feeling inside the rectum to check the prostate gland, as part of their initial assessment.

Source guidance

  • Lower urinary tract symptoms (NICE clinical guideline 97), recommendation 1.1.2 (key priority for implementation).

Definitions of terms used in this quality statement

Physical examination

An examination of the abdomen and external genitalia, and a digital rectal examination. NICE clinical guideline 97 recommends physical examination at initial assessment guided by urological symptoms and other medical conditions.

Digital rectal examination

A routine test that is used to detect abnormalities of the prostate gland. The doctor or nurse inserts a gloved and lubricated finger (digit) into the man's rectum, which lies just behind the prostate gland.

Initial assessment

Initial assessment refers to the first assessment within the assessment process, carried out in any setting by a healthcare professional without specific training in managing LUTS in men. Initial assessment may involve a range of assessments as outlined in NICE clinical guideline 97 depending on the presenting symptoms. Based on expert consensus, the initial assessment may involve more than 1 consultation but normally no more than 3 consultations.

Equality and diversity considerations

When offering a digital rectal examination, healthcare professionals should provide information about the examination that reflects any religious, ethnic, transgender or cultural needs and takes into account learning disabilities, or difficulties in communication or reading.

Men provided with information should have access to an interpreter or advocate if needed.