Abd-Chap.23-24 Prostate & scrotum NH

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The Central zone is the ____ located portion of the prostate gland.

Superiorly

The ____ is a connective tissue separating the *peripheral and central zone*

Surgical capsule

Cysts are associated with ____. (scrotum)

*Extratesticular* spermatoceles

Abdominal malignancy invading the ____ vein may cause a ____ with noncompressible veins.

*Left* renal Varicocele

Most hydroceles are congenital and are noted in boys ages ____ years of age.

1-2

The pampiniform plexus converges into which 3 sets of anastomotic veins?

1. Testicular 2. Deferential 3. Cremasteric

When scanning the scrotum, use a high-frequency probe between ____ MHz.

10 to 14 MHz

The head of the epididymis contains ____ efferent ductules from the rete testis, which converge to form a single duct in the body and tail .

10 to 15

The degree of torsion varies between ____ degrees.

180 - 540

Varicoceles measure > ____ mm in diameter.

2 mm

If surgery is performed after *12 hours* of the onset of pain in a torsed teste, ____% of the testes can be salvaged.

20%

Microcalcifications are < ____ mm and are usually a ____ condition.

3 mm Bilateral

Cysts are more common in men over ____ years of age.

40

Treatment of a varicocele(s) has improved sperm count in approximately ____% of cases.

50%

____ degrees is referred to as complete torsion.

540

Up to ____% of torsion patients have the anatomic anomaly on both sides.

60%

If surgery is performed within *6-12 hours* of the onset of pain in a torsed teste, ____% of the testes can be salvaged.

70%

If surgery is performed within ____ hours following an injury, up to 90% of testes can be saved, but only 45% can be saved after that.

72 hrs

If surgery is performed within *5-6 hours* of the onset of pain in a torsed teste, ____% to ____% of the testes can be salvaged.

80% 100%

The right and left testicular arteries arise from the ____ below the level of the ____ arteries.

Abdominal aorta Renal

____ is the most common condition that causes acute scrotal pain.

Acute epididymitis

The vas deferens dilates at the terminal portion near the seminal vesicles and is termed the ____.

Ampulla of the deferens

Hydroceles may appear ____ or contain ____.

Anechoic Low-level echoes

Causes of ____ include intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero.

Anorchia

Unilateral ____ is found in 4% of patients with nonpalpable testis.

Anorchia

____ is also referred to as monorchidism.

Anorchia

____ is more common on the *left side*; definitive diagnosis depends on surgical diagnosis.

Anorchia

The prostate is located ____ to the rectum, ____ to the bladder, and behind the inferior border of the ____.

Anterior Inferior Symphysis pubis

The peripheral zone extends into the ____ of the prostate.

Apex

The caudal end (prostate) is referred to as the ____ and is adherent to the ____.

Apex Urogenital diaphragm

The ____ is a rare structure that is derived from the Wolffian duct.

Appendix epididymis

The ____ is a small protuberance from the head of epididymis.

Appendix epididymis

The ____ represents a detached efferent duct.

Appendix epididymis

The ____ is a remnant of the Müellerian duct

Appendix testis

The ____ is a small ovoid structure located beneath the head of the epididymis that can torse and cause severe pain.

Appendix testis

Blood vessels, lymphatics, nerves, and spermatic ducts travel through the ____.

Bare area

____ is the most common cause of torsion.

Bell clapper deformity

____ occurs when the tunica vaginalis completely surrounds the testis, epididymis, and distal spermatic cord, allowing them to move and rotate freely within scrotum.

Bell clapper deformity

____ is an enlargement of the prostate that occurs in the transitional zone of the prostate.

Benign Prostatic Hyperplasia (BPH)

Evaluation of tumor markers ____, ____, and ____ require further investigation.

Beta-HCG AFP LDH

Cryptorchidism is ____ in 10% to 25% of cases.

Bilateral

Metastasis to testicle is ____, with multiple lesions found.

Bilateral

The ____ of the epididymis follows the *posterolateral* aspect of the testis from the upper to lower pole.

Body

The ____ of the epididymis is smaller than the head, making it difficult to see sonographically in normal individuals, while the ____ is slightly larger and positioned posterior to the lower pole of the testis .

Body Tail

____ is the most commonly herniated structure, followed by ____.

Bowel Omentum

The ____ zone is the superiorly located portion of the prostate gland, and accounts for about 25% of the glandular tissue.

Central

____ arteries course from the testicular surface toward the mediastinum and branch into multiple rami arteries.

Centripetal

Terminal intratesticular arteries arising from the capsular arteries.

Centripetal artery

____ has the worst prognosis of any of the germ cell tumors, with death occurring within one year of diagnosis.

Choriocarcinoma

____ is a rare germ cell tumor that is seen in less than 1% of patients and usually occurs between the ages of 20 and 30.

Choriocarcinoma

____ may be associated with severe epididymitis and orchitis and will have thick septations with contain low-level echoes.

Complex hydroceles

The ____ artery branches from the inferior epigastric artery (branch of the external iliac artery).

Cremasteric

Small artery arising from the inferior epigastric artery, which supplies the peritesticular tissue and cremasteric muscle.

Cremasteric artery

Extension of the internal oblique muscle that descends to the testis with the spermatic cord.

Cremasteric muscle

Syptoms: Undescended testis smaller and less echogenic than normal testis Usually oval with a homogeneous texture Mediastinum is rarely seen

Cryptorchidism

Testicles remain in the abdomen or groin and fail to descend into the scrotal sac.

Cryptorchidism

____ components are found in up to one third of embryonal cell carcinomas.

Cystic

The ____ is a layer of muscle fibers, lying beneath the scrotal skin and dividing the scrotum into two chambers.

Dartos

The ____ artery arises from the vesicle artery (branch of internal iliac artery).

Deferential

____ and ____ arteries accompany the testicular artery within the cord to supply the extratesticular structures.

Deferential Cremasteric

Arises form the vesicle artery an supplies the vas deferens and epididymis.

Deferential artery

What is the primary goal of sonography in regards to malignant germ cell tumors of the testicle?

Determine the mass *location* Differentiate between *cystic/solid* composition

Seminoma spreads initially to the ____ in the retroperitoneum.

Draining lymph nodes

The single duct in the body and tail is known as the ____.

Ductus epididymis

An ____ cannot be manipulated into correct path of descent.

Ectopic testicle

The head of the epididymis contains 10 to 15 ____ from the ____, which converge to form a single duct in the body and tail.

Efferent ductules Rete testis

Duplicated testis are usually small and the ____ is completely absent.

Efferent spermatic system

Connect the seminal vesicles and the vas deferens to the urethra at the verumontanum.

Ejaculatory ducts

____ is the most aggressive of the *primary* scrotal malignancies.

Embryonal cell carcinoma

____ occurs primarily in men between 25 and 35 years of age and is the second most common histologic type of testicular tumor after seminoma.

Embryonal cell carcinoma

Cyst filled with clear, serous fluid located in the epididymis.

Epididymal cyst

____ are small, clear cysts containing serous fluid, located within the epididymis.

Epididymal cysts

Spermatoceles are always located in the ____.

Epididymal head

A normal ____ shows little flow with color Doppler; affected side shows significantly more flow than asymptomatic side.

Epididymis

Anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single convoluted epididymal tubule.

Epididymis

The deferential artery mainly supplies the ____ and ____.

Epididymis Vas deferens

A sperm granuloma may be located anywhere within the ____ or ____ .

Epididymis Vas deferens

Presenting symptoms: Enlarged, hypoechoic gland Secondary hemorrhage containing focal hyperechoic areas Hyperemic flow Reactive hydrocele Scrotal wall thickening

Epididymitis

Spermatoceles result from prior episodes of ____.

Epididymitis

____ may result from trauma; color Doppler imaging can be used to identify associated increased vascularity in epididymis.

Epididymitis

The epigastric artery is a branch of the ____artery.

External iliac

Most ____ masses are benign, but the majority of ____ lesions are malignant.

Extratesticular Intratesticular

Most scrotal cysts are ____, and found in the ____ or ____.

Extratesticular Tunica albuginea Epididymis

With ____, color flow will be demonstrated only in portions of the testis with a heterogeneous/hypoechoic appearance.

Focal infarction

Image the right and left testicle together for comparison in both ____ and ____.

Gray scale Color Doppler

The ____ of the epididymis is located superior to the upper pole of the testis.

Head

An acute ____ is echogenic with numerous, highly visible echoes that can be seen to float or move in real time.

Hematocele

Blood formed btwn the visceral and parietal layers of the tunica vaginalis.

Hematocele

____ are collections of blood associated with trauma, surgery, neoplasms, or torsion.

Hematoceles

____ contain blood; found in advanced cases of epididymitis or orchitis.

Hematoceles

____ are associated with trauma and may be large and cause displacement of the associated testis; appear as heterogeneous areas becoming more complex with time, developing cystic components.

Hematomas

____ may involve testis or epididymis, or they can be contained within scrotal wall.

Hematomas

Fluid formed btwn the visceral and parietal layers of the tunica vaginalis.

Hydrocele

A ____ and ____ are both complications of trauma to the scrotum.

Hydrocele Hematocele

____ are found around the anterolateral aspect of the testis.

Hydroceles

____ contain serous fluid and are the most common cause of painless scrotal swelling.

Hydroceles

____ may be idiopathic, but are commonly associated with trauma, neoplasms, epididymo-orchitis and torsion.

Hydroceles

____ is seen in the epididymis and testis when both are involved, but is restricted to the epididymis only, if the testis is normal.

Hyperemic flow

A condition in which the opening of the penis is on the underside rather than the tip.

Hypospadias

If surgery is not performed on undescended testis at an early age, numerous complications can occur to include ____, ____, and____.

Infertility (subjected to higher temps.) Torsion Testicular cancer

Testes should descend into the scrotum from the ____ shortly before birth or early in the neonatal period.

Inguinal canal

The vesicle artery is a branch of the ____ artery.

Internal iliac

If varicoceles are greater on the right side, look at the ____, checking for a right ____.

Kidneys Renal mass

Varicoceles are more common on the ____ side, usually due to the ____ vein becoming compressed between the ____ and the ____.

Left (90%) Left renal Aorta SMA

The ____ vein joins left renal vein.

Left testicular

Of children with ____, 8% have been reported to have testicular involvement.

Leukemia

____ involvement of the testicle is the next most common secondary testicular neoplasm; most often found in children.

Leukemia

Although considered in the benign group, 10% to 15% of ____ tumors are in fact malignant.

Leydig cell

____ tumors are also referred to as gonadal stromal tumors.

Leydig cell

____ tumors are the most common non-germ cell (stromal) neoplasm of the testis.

Leydig cell

____ are always benign in children, malignant variants have been reported in adults.

Leydig cell tumors

The right and left testicular arteries have ____, demonstrating low-flow velocity of ____ cm/s.

Low-resistance 15 cm/s

Centripetal arteries have ____ flow, demonstrating low-flow velocity of ____ cm/s.

Low-resistance 5 to 20

Malignant ____ accounts for 1 - 7% of all testicular tumors; most common ____ testicular neoplasm affecting men > ____ years.

Lymphoma Bilateral secondary 60

____ tumors are the most common testicular cancers.

Malignant germ cell

Risk factors include: Cryptorchidism Family history Infertility Klinefelter syndrome (XXY) Down syndrome Smoking Caucasian (4.5 times more common than in African Americans)

Malignant germ cell tumors

Symptoms: Painless lump Testicular enlargement Vague discomfort in the scrotum

Malignant germ cell tumors

Cysts are located near the ____ (Scrotum)

Mediastinum

Central linear structure formed by the convergence of multiple thin septations within the testicle, which are invaginations of the tunica albuginea.

Mediastinum testis

____ appears as a solid hypoechoic mass, although it has been reported as hyperechoic or a mixture of both.

Metastasis

____ to the testicle is rare, normally occurring later in life.

Metastasis

____ has been associated with cryptorchidism, Klinefelter's syndrome, infertility, varicoceles, testicular atrophy, and male pseudohermaphroditism.

Microlithiasis

Testicles commonly rotate toward the ____.

Midline

____ germ cell tumors constitute approximately 40% to 60% of all nonseminoma germ cell tumors.

Mixed

____ is not affected by cancer, prostatitis, or hyperplasia.

Non-glandular tissue

____ are masses that are not "pure seminomas" and consist of other cell types such as embryonal cell carcinoma, choriocarcinoma, teratoma, yolk sac tumor, and mixed germ cell tumors.

Nonseminomas

The method of treatment of an embryonal cell carcinoma is a radical ____.

Orchiectomy

Surgical treatment for an undescended testicle is called a ____.

Orchiopexy

Testicular infarction may occur in severe cases of ____.

Orchitis

____ almost always occurs secondary to epididymitis.

Orchitis

____ presents with an enlarged hypoechoic testicle, increased blood flow, and decreased arterial resistance.

Orchitis

Manual detorsion involves rotating the painful testicle ____ like "opening a book".

Outward

Decreasing the ____ will better optimize slow blood flow to rule out a complete torsion.

PRF (color scale)

The ____ exits from the mediastinum testis and courses in the spermatic cord.

Pampiniform plexus

Veins of the ____ are located within the spermatic cord.

Pampiniform plexus

Venous drainage of the scrotum occurs through veins of the ____.

Pampiniform plexus

When an intratesticular mass is discovered, the ____ should be evaluated for lymphadenopathy.

Paraaortic region

What are the 3 different types of torsion?

Partial testicular torsion (PTT) Torsion-detorsion syndrome (TDS) Intermittent testicular torsion (ITT)

The cremasteric artery supplies the ____ tissues.

Peri-testicular

____ of the bowel, seen with real-time imaging, confirms the diagnosis of a scrotal hernia.

Peristalsis

An increased incidence of malignancy, cryptorchidism, inguinal hernia, and torsion is common with ____.

Polyorchidism

____ is a very rare disorder; more common on *left side* (75%); *bilateral* in 5% of cases (scrotum)

Polyorchidism

The right and left testicular arteries course along the ____ surface of each testis and pierce the ____, forming the ____ arteries.

Posterior Tunica albuginea Capsular

When matastasis to the testicle occurs, the primary tumor may originate from the ____ or ____; less common sites include lung, pancreas, bladder, colon, thyroid, or melanoma.

Prostate Kidneys

Spermatoceles contain ____ fluid and ____.

Proteinaceous Spermatozoa

Partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis.

Pudendal artery

A ____ occurs with an untreated infection or when an abscess ruptures into space between layers of tunica vaginalis.

Pyocele

A ____ usually contains internal septations, loculations, and debris.

Pyocele

A ____ occurs when pus fills the space between the layers of the ____.

Pyocele Tunica vaginalis

Centripetal arteries course from the testicular surface toward the mediastinum and branch into multiple ____ arteries.

Rami

Terminal ends of the centripetal arteries.

Recurrent rami

Network of channels formed by the convergence of the straight seminiferous tubules in the mediastinum testis.

Rete testis

The ____ is located at the hilum of the testis where the mediastinum resides.

Rete testis

The right and left testicular arteries descend in the ____ and enter the spermatic cord in the ____.

Retroperitoneum Deep inguinal ring

During fetal growth, the testes first appear in the ____ near the ____.

Retroperitoneum Kidneys

The ____ arteries are the primary source of blood flow to the testis.

Right and left testicular

____ arteries arise from the abdominal aorta below the level of the renal arteries.

Right and left testicular

The ____ vein drains into the inferior vena cava.

Right testicular

Blood flow disruption across surface of testis indicates ____.

Rupture

Acute epididymitis is most commonly caused by ____ in men *under the age or 35*.

STDs *ie: Chlamydia trachomatis and Neisseria gonorrhea

____ occur when bowel, omentum, or other structures herniate into the scrotum.

Scrotal hernias

The division of the two scrotal chambers is called the ____.

Scrotal raphe

Sonographic findings associated with a ____: Focal alteration of testicular parenchymal pattern Interruption of tunica albuginea Irregular testicular contour Scrotal wall thickening Hematocele

Scrotal rupture

Polyorchidism is usually found in the ____; has also been found in the inguinal canal or retroperitoneum.

Scrotum

____ may be a result of renal hydronephrosis, an abdominal mass, or liver cirrhosis.

Secondary varicoceles

In men, the urethra transports both urine and ____ outside the body.

Semen

The ____ act as reservoirs for seminal fluid.

Seminal vesicles

The vas deferens joins the ____ to form the_____, which empties into urethra.

Seminal vesicles Ejaculatory duct

____ is the most common germ cell tumor.

Seminoma

Malignant germ cell tumors are classified as either ____ or ____ based on their histology.

Seminoma Nonseminoma

____ are radiosensitive and chemosensitive resulting in the most favorable prognosis of all testicular tumors.

Seminomas

____ tend to be homogeneous, hypoechoic masses with a smooth border. They do not often contain calcification or cystic components.

Seminomas

Multiple septa formed from the tunica albuginea that course toward the mediastinum and separate the testicle into lobules.

Septa testis

The ____, ____, and ____ of each testis is evaluated.

Size Echogenicity Structure

____ are most frequently seen in patients with a history of vasectomy.

Sperm granulomas

____ are seen as *well-defined solid masses*, that may appear *hypoechoic or isoechoic* to the epididymis.

Sperm granulomas

____ occur as chronic inflammatory reaction to extravasation of spermatozoa.

Sperm granulomas

*Secondary varicoceles* are caused by increased pressure on the ____.

Spermatic *vein*

The vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, autonomic nerves, and fiber of cremaster form the ____.

Spermatic cord

Torsion of the ____ is a surgical emergency and the number of twists also affects testicular salvage.

Spermatic cord

The ____ extends from the scrotum through the *inguinal canal* and *internal inguinal rings* to the ____.

Spermatic cord Pelvis

Cyst in the vas deferens containing sperm.

Spermatocele

____ are cystic dilatations of the efferent ductules of the epididymis.

Spermatoceles

What are the 3 types of scrotal cysts?

Spermatoceles Epididymal cysts Tunica albuginea cysts

The most common site for an ectopic testicle to rest is the ____ Other sites: Perineum Femoral canal Suprapubic area Penis Diaphragm Other scrotal compartments.

Superficial inguinal pouch

Each testis is scanned from ____ to ____, beginning midline to demonstrate symmetry; asymptomatic side first.

Superior Inferior

The most common mixed germ cell neoplasm is a ____.

Teratocarcinoma

A ____ may show dense foci that produces acoustic shadowing and are normally heterogeneous but have well-defined borders.

Teratoma

A ____ is the second most common testicular neoplasm in children occuring in children under the age of ____.

Teratoma 4

____ are usually benign in children but malignant in adults.

Teratomas

Artery arising from the aorta just distal to each renal artery.

Testicular artery

____ is the most common malignancy in men between ages of 15 and 35.

Testicular cancer

____ is one of the most curable forms of cancer and occurs most frequently between ages of ____ and ____.

Testicular cancer 20 34

Formed by the pampiniform plexus.

Testicular vein

The spermatic cord suspends the ____ in the scrotum.

Testis

Leydig cell tumors produce ____ resulting in precocious puberty.

Testosterone

If the entire testis becomes infarcted, the sonographic appearance is the same as a ____.

Torsion

Presenting symptoms: Sudden onset of scrotal pain Swelling on the affected side Nausea and vomiting

Torsion

Sensitize color Doppler for slow flow when evaluating ____.

Torsion

____ compromises blood flow to testis, epididymis, and the intrascrotal portion of spermatic cord.

Torsion

____ occurs as a result of abnormal mobility of the testis within scrotum.

Torsion

____ is the most common cause of acute scrotal pain in adolescents, peaking in incidence at age ____.

Torsion 14

____ is an uncommon, benign condition associated with the presence of a spermatocele, epididymal, or testicular cyst, or another epididymal obstruction on the same side as the ____.

Tubular ectasia of the rete testis Dilated tubules

Inner fibrous membrane surrounding the testis.

Tunica albuginea

Swollen testis are confined within the rigid ____.

Tunica albuginea

Membrane consisting of the Visceral and Parietal layers lining the inner wall of the scrotum.

Tunica vaginalis

Normally, the testis and epididymis are surrounded by the ____, except at the ____ where they are attached to the ____.

Tunica vaginalis Bare area Posterior scrotal wall

Acute epididymitis is most commonly caused by ____ in *pre-pubertal boys and men older than 35*.

UTIs

____ testes are 10 times more likely than normal testes to be affected by torsion.

Undescended

____ testes are 2.5 to 8 times more likely to develop cancer.

Undescended

Testicular parenchyma should be ____ with an equal echogenicity between both sides.

Uniform

The ____ courses from the bladder to the end of the penis.

Urethra

Perform a ____ when a varicocele is suspected.

Valsalva maneuver

Varicoceles tend to increase in diameter in response to ____.

Valsalva maneuver

A ____ is an abnormal dilation of veins of the pampiniform plexus.

Varicocele

A ____ is associated with impaired fertility and is more common in infertile men.

Varicocele

A ____ is the most common correctable cause of male infertility.

Varicocele

Sonographic evaluation of a ____ shows numerous tortuous tubes of varying sizes within the spermatic cord near the ____.

Varicocele Epididymal head

The ____ dilates at the terminal portion near the seminal vesicles.

Vas deferens

The ____ is a continuation of the ductus epididymis and is thicker and less convoluted.

Vas deferens

The ductus epididymis becomes the ____ and continues in the spermatic cord.

Vas deferens

Tube that connects the epididymis to the seminal vesicle.

Vas deferens

Testis and epididymis twist within scrotum, cutting off ____ supply within spermatic cord.

Vascular

Spermatoceles may be seen more often following a ____.

Vasectomy

In torsion, ____ flow is affected first with occluded ____, causing swelling of the scrotal structures on the affected side, followed by ____ flow and testicular ischemia.

Venous Veins Arterial

*Primary varicoceles* are usually caused by incompetent ____ within the spermatic vein.

Venous valves

Junction of the ejaculatory ducts with the urethra.

Verumontanum

The junction of ejaculatory ducts with urethra is called the ____.

Verumontanum

A potential space exists between the ____ and ____ layers of the tunica vaginalis, where a hydrocele, pyocele, or hematocele may develop.

Visceral Parietal

The appendix of the epididymis is a rare structure that is derived from the ____.

Wolffian duct

A ____ accounts for 80% of childhood testicular tumors before the age of ____.

Yolk sac tumor 2

Risk factors of prostate cancer include ____, ____, and ____.

*Age* - *>80%* of prostate cancers are diagnosed in men *over 65* *Race* - African American men are *twice* as likely to develop prostate cancer than Caucasian men *Genetics* - Having a first-degree relative with prostate cancer makes a man *two to three times* more likely to develop the disease

The tubules converge to form the ____ at the apex of each lobule and connect the ____ to the ____ in the mediastinum.

*Tubuli recti* Seminiferous tubule Rete testis

Staging of Prostate cancer is used to determine the type of treatment and is an indicator of prognosis to include what 4 stages?

1. Clinically non-palpable 2. Palpable nodule confined to the prostate 3. Palpable nodule extending through the capsule 4. Metastases

Testis measure ____ cm.

3-5 x 2-4 x 3 cm

The prostate measures approximately ____ cm.

4 x 3 x 2 cm

Benign Prostatic Hyperplasia (BPH) is commonly seen in men over the age of ____, and peaks around the age of ____.

40 60

Each testis is divided into ____ conical lobules containing the seminiferous tubules.

> 250 to 400

The prostate secretes ____ to transport sperm.

Alkaline fluid

Prostate secretions contain ____, ____, and ____.

Alkaline phosphatase Citric acid Prostate specific antigen (PSA)

The prostate has been divided into which five lobes?

Anterior Middle Posterior 2 Lateral

The inferior vesical artery supplies blood to the base of the ____, ____, and the ____.

Bladder Seminal vesicles Ureter

There is a small ____, which is posterior where the testicle is against the scrotal wall, preventing torsion; it is normal to see a small amount of physiologic fluid in this space.

Bare area

The cephalic portion of the gland (prostate) is referred to as the ____, and is continuous with the ____.

Base Bladder neck

Ejaculatory duct cysts are typically seen between the ____ of the prostate and the ____, and can occur along the ejaculatory duct course.

Base Seminal vesicles

____ is the most common symptomatic tumor-like condition in the male population.

Benign Prostatic Hyperplasia (BPH)

The Transitional zone is the site of origin of ____.

Benign Prostatic hyperplasia (BPH)

Each testis is divided into > 250 to 400 ____ containing the ____.

Conical lobules Seminiferous tubules

Ejaculatory duct cysts contain ____ when aspirated.

Spermatozoa

Because the urethra passes through the Transitional zone, patients with BPH typically present with ____, ____, and ____.

Difficult initiation of voiding Urinary frequency Small stream

The prostate produces 80%-85% of the ____ and PSA.

Ejaculation fluid

An ____ can occur due to a distal obstruction of the spermatic ductal system by a congenital abnormality or inflammation.

Ejaculatory duct cyst

____ result in hematospermia, ejaculatory pain, and infertility.

Ejaculatory duct cysts

The ____ pass through the central zone from the seminal vesicles to the urethra.

Ejaculatory ducts

____ travel through the prostate gland to the midline where they join the urethra at the ____.

Ejaculatory ducts Verumontanum

Müllerian Duct Cysts are attached to the prostate by a ____ extending into the prostate.

Stalk-like structure

The ____ is a 6- to 7-cm tubular structure beginning superiorly and then coursing postero-laterally to the testis, divided into the head, body, and tail.

Epididymis

The rete testis is a network of tubules that carry sperm to the head of the ____ through the ____.

Epididymis Efferent ductules

The ____ is the most anteriorly located non-glandular portion of the prostate.

Fibromuscular stroma

Clinical findings of prostatitis include urinary ____, ____, and ____.

Frequency Urgency Dysuria

The adult prostate is a funnel or cone shaped, ____ structure surrounded by a ____ capsule.

Glandular Fibrous

The ____ system is used to evaluate the prognosis of men with prostate cancer based upon its microscopic appearance.

Gleason Grading

The ____ of the epididymis is the largest part, ____ mm in width.

Head *6 to 15 mm* *mm !*

____ form in the space between layers of tunica vaginalis.

Hydroceles

The classic appearance of prostate cancer on ultrasound is a ____, peripherally-oriented lesion.

Hypoechoic

The ____ artery provides blood supply to the base of the bladder, seminal vesicles, and ureter.

Inferior vesical

____ is another indication for TRUS.

Infertility

The prostaticovesical arteries arise from the ____ arteries on each side.

Internal iliac

Compared to the normal testicle the epididymis is normally ____ or slightly more ____.

Isoechoic Echogenic

Zonal anatomy is the current method of choice where the prostate is divided into four primary zones known as ____.

McNeal's concept

The ____ is the area where nerves and blood vessels enter the testicle.

Mediastinium testis

The ____ supports the vessels and ducts coursing within the testis.

Mediastinum

A ____ is the most common of the male pelvic cystic masses.

Müllerian Duct Cyst

____ occur because of failure of regression of the müllerian duct structures.

Müllerian Duct Cysts

____ typically extend above the base of the prostate just off midline and are found between the *bladder and rectum*.

Müllerian Duct Cysts

____ is the most common blood test utilized to identify men at increased risk of prostate cancer.

PSA

The ____ layer is the inner lining of the scrotal wall.

Parietal

The Tunica vaginalis consists of which 2 layers?

Parietal Visceral

The ____ zone is the location of most prostate cancers (70%) and prostatitis.

Peripheral

The ____ zone, or outer gland, is the posteriorly located portion of the prostate containing 70% of the prostatic glandular tissue.

Peripheral

McNeal's concept divides the prostate into which 4 zones?

Peripheral zone Transition (periurethral) zone Central zone Fibromuscular stroma

The Peripheral zone, or outer gland, is the ____ located portion of the prostate gland.

Posteriorly

The most common clinical complaints warranting a ____ sonogram include: Enlarged prostate Hematospermia Pain on ejaculation Dysuria Decreased urine output Urinary frequency/urgency Infertility Elevated PSA Perineal pain

Prostate

____ cancer is the most common cancer in American men, and the second most deadly male cancer with approximately 200,000 cases reported in the US each year with a mortality of 30,000 cases per year.

Prostate

Increased ____ levels can occur in patients with Benign Prostatic Hypertrophy (BPH), infection, or prostate cancer.

Prostate Specific Antigen (PSA)

PSA levels should be compared to the ____.

Prostate volume

The ____ artery provides blood supply to the prostate gland and gives rise to the urethral and capsular arteries.

Prostatic

Prostaticovesical arteries give rise to the ____ artery and the ____ artery.

Prostatic Inferior vesical

PSA is a protein that is specific to the ____.

Prostatic epithelium

The prostate is supplied by the ____ arteries.

Prostaticovesical

Sonographic findings of ____ include a diffuse hyperechoic parenchyma or atrophy in chronic cases. (Prostate)

Prostatitis

____ is caused by an infection of the prostate; can be acute or chronic.

Prostatitis

____ is one of the most common causes of prostate related symptoms.

Prostatitis

The prostate is composed of glandular and fibromuscular tissue and surrounds the ____.

Proximal male urethra

The ____ is a network of tubules that carry sperm to the head of the epididymis through the efferent ductules.

Rete testis

____ cysts are small in size (usually 1 to 2 cm), and are typically clinically insignificant; may occur in any of the three glandular zones.

Retention

A ____ is an acquired cyst of the prostate as a result from occlusion of a prostatic duct causing dilation of the glandular acini.

Retention cyst

What 3 luminal structures are found traverse to the prostate gland?

Right and left ejaculatory ducts Urethra

The ____ are two sac-like out-pouchings of the vas deferens situated adjacent to the superior/posterior aspect of the prostate, between the urinary bladder and rectum.

Seminal vesicles

Male infertility may be related to a congenital abnormality such as agenesis or atresia of the ____ or ____ obstruction secondary to a cyst, mass, or calcification.

Seminal vesicles Ejaculatory duct

Multiple septations known as ____ arise from the tunica albuginea to form the ____.

Septula Mediastinum testis

____ should be performed with the patient's bladder *empty* to decrease discomfort; all other prostate exams are done with a full bladder.

TRUS

____ and ____ regulate prostate growth and function.

Testosterone Dihydrotestosterone

The ____ zone contains 5% of the prostatic glandular tissue and is also known as the Periurethral zone.

Transitional

Benign Prostatic Hyperplasia (BPH) occurs in the ____ zone.

Transitional (periurethral)

____ is used to evaluate patients with an abnormal digital rectal exam (DRE), abnormal prostate-specific antigen (PSA) results, as well as for guidance during a biopsy.

Transrectal ultrasound (TRUS)

The ____ is the region where the ejaculatory ducts enter the urethra and divides the urethra into proximal and distal segments.

Verumontanum

The ____ layer surrounds the testis and the epididymis.

Visceral

The Surgical capsule is a boundary line used in ____ procedures.

Transurethral resection

A procedure called ____ is done to relieve the symptoms caused by compression of the prostatic urethra, using a cystoscope, a surgeon removes the excess tissue, thus creating a large defect.

Transurethral resection of the prostate (TURP)

The testis are covered by dense, fibrous tissue termed ____.

Tunica albuginea

The ____ lines the inner walls of the scrotum, covering each testis and epididymis.

Tunica vaginalis

Ejaculatory ducts pass through the central zone and empty into the ____.

Urethra

The ____ is located in the central portion of the prostate gland.

Urethra

The prostatic artery gives rise to the ____ and ____ arteries.

Urethral Capsular

____ are *endodermal* in origin and are usually associated with hypospadias, undescended testicles, and renal anomalies.

Utricle cysts

____ are located midline and close to the *verumontanum*, are typically smaller in size than müllerian duct cysts, and have a *tear drop* shape.

Utricle cysts

The seminal vesicles are two sac-like out-pouchings of the ____ situated adjacent to the superior/posterior aspect of the ____, between the ____ and ____.

Vas deferens Prostate Urinary bladder Rectum

Ejaculatory ducts originate from the combination of the ____ and the _____.

Vas deferens Seminal vesicle

The ____ divides the urethra into proximal and distal segments.

Verumontanum

The ____ is a longitudinal ridge within the urethra; ejaculatory ducts are located on either side.

Verumontanum


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