Abd-Chap.23-24 Prostate & scrotum NH
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
