The significance of bimanual bladder examination in the diagnosis of bladder cancer

For middle-aged and elderly patients with painless macroscopic hematuria, bladder tumors should be considered first. Laboratory tests of urine, abdominal B-ultrasound examinations, cystoscopy, and bimanual bladder examinations can help to make a clear diagnosis of the disease.

When the normal bladder is empty, it is hidden in the pelvic cavity and is not easy to touch. Only when the bladder is filled with urine and swollen, it will go beyond the upper edge of the pubic bone and be touched in the middle of the lower abdomen. The method of bimanual bladder examination is: insert the gloved index finger of the right hand into the rectum and push forward, and apply pressure on the pubic symphysis with the four fingers of the left hand. A lump can be touched behind the pubic symphysis deep in the abdominal cavity. After touching the lump, its nature and characteristics should be examined in detail. Bladder enlargement is mostly caused by urine accumulation. It is oblate or round, feels cystic, cannot be moved by hand, swells when pressed, and has the urge to urinate. It shrinks or disappears after urination or catheterization. It can be differentiated from pregnant uterus, ovarian cysts and rectal tumors.

This examination method can understand the size of the tumor, the range and depth of infiltration, and the relationship with the pelvic wall. During the examination, the patient lies in the supine position, the abdominal muscles should be completely relaxed, and the examiner should move gently to avoid causing pain and discomfort to the patient and to avoid tumor bleeding and metastasis.

Bimanual bladder examination is only suitable for patients with thin and soft abdominal walls. For obese patients or those with more abdominal fat, it is easily affected by other tissues, making it difficult to make a clear diagnosis, and more imaging examinations are required.