To evaluate whether "cross-leg lithotomy" (CL) is better position for digital rectal examination (DRE) than left lateral (LL) position from urologist and patient’s perspective.

Two urologists performed DRE in 120 patients in LL and CL positions. Each patient was randomised, sequentially examined in both positions and responses were objectively assessed using a questionnaire and statistically analysed.

Men found DRE uncomfortable [LL (81.7%), CL (85.0%)] and embarrassing [LL: (81.7%), CL (78.3%)] in both the positions. DRE was painful [LL (11.7%), CL (8.3%)] with a mean pain score of 1.92 and 1.85 respectively. Patient apprehension regarding pain was significantly higher [LL (62.5%) vs. CL (21.7%), p < 0.001] in LL position. Overall, men preferred CL to LL position [CL (78.3%), LL (21.75%), p < 0.001] for DRE. From urologist perspective, the extent of prostate felt in CL position was significantly higher (CL: 11.15 ± 1.96/12 vs. LL: 9.25 ± 2.50/12, p < 0.001). Withdrawal response was significantly higher in LL and urologist had to sit down to perform DRE in LL position.

Men preferred CL to LL position for DRE and CL allowed more complete examination of the prostate from urologist perspective. CL position is a better alternative for performing DRE of the prostate.