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J Urol. 2013 Aug;190(2):667-72. doi: 10.1016/j.juro.2013.02.3201. Epub 2013 Mar 7.

Rectal examination in children: digital versus transabdominal ultrasound.

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  • 1Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.



We investigate 2 diagnostic tests to assess the rectal filling state.


The rectal filling state was assessed with transabdominal ultrasound or with digital rectal examination by 2 independent investigators in children with urological problems before a scheduled diagnostic or surgical urological procedure. A dilated rectum filled with stool or large amounts of (usually) hard stool were both considered as a rectal fecal mass. All investigations were performed with the patient under general anesthesia. The kappa test was used to evaluate agreement between transabdominal ultrasound and digital rectal examination.


A total of 84 children (54 boys) with a median (p25-p75) age of 9.0 years (6.4-11) were eligible candidates. A rectal mass was found on transabdominal ultrasound and digital rectal examination in 32% and 41% of all children, respectively, with agreement between the 2 tests in 82.5%. Cohen's kappa showed good agreement of 0.62 (95% CI 0.45-0.79) between transabdominal ultrasound and digital rectal examination. The median (IQR) diameter of the rectum was 3.3 cm (2.8-3.9) in children with a full rectum, and 2.5 cm (1.8-2.8) and 2.0 cm (1.5-2.2) in patients with a half filled and empty rectum, respectively.


Transabdominal ultrasound is a noninvasive and reliable alternative to assess the rectal filling state, and might replace digital rectal examination in the evaluation of children with constipation.

Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.


FC; RE; US; child; constipation; diagnosis; digital rectal examination; functional constipation; ultrasound

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