Male Pelvis

Prostate cancer will elevate PSA level approximately ___ times that of benign prostatic hyperplasia.

10

At least _____ degrees of torsion is considered necessary to completely occlude testicular blood flow.

540

What type of transducer is best for scrotal sonography?

7.5-10 MHz linear

Cryptorchidism is a common genitourinary anomaly. Complete descent is necessary for full testicular maturation. Where is the undescended testicle normally found?

80% are found in the inguinal canal

Dilated veins of a varicocele will measure:

>2mm

What is the etiology of a hydrocele?

Congenital Acquired: idiopathic or trauma, torsion, etc.

What is the appendix epididymis?

Detached efferent duct

What is the most common malignancy of the testicles?

Embryonal cell carcinoma

What are the 3 sonographic findings associated with acute epididymits?

Enlarged epididymis with decreased echogenicity and inhomogenous echo texture Reactive hydrocele Skin thickening

Define benign prostatic hyperplasia (BPH).

Enlargement of the inner gland transition zone

What is the tunica vaginalis?

Extension of the peritoneum into the scrotal chamber that resides along the side of the testicle

What is the tunica albuginea?

Fibrous capsule that surrounds the testicle

What are the 5 sonographic findings of testicular torsion?

Hypoechoic or heterogenous testis, reactive hydrocele, no intratesticular flow, enlargement of the spermatic cord, epididymis, and testis, thickened scrotal wall

What are two complications of cryptorchidism?

Infertility and cancer

What is the difference between primary and secondary varicoceles?

Primary: right side Secondary: left side

Describe the Prostate-Specific Antigen (PSA).

Produced by prostatic acinar cells and rises in relationship to amount of benign and/or malignant tissue

What is the appendix testis?

Remnant of the Mullerian duct

How does the appendix testis appear sonographically?

Small ovoid structure near the head of the epididymis

Both orchitis and testicular torsion sonographically appear as an enlarged hypoechoic testicle. How would you differentiate between these two diagnoses?

Torsion: absence of intratesticular flow Orchitis: hypervascularity

What is the name of the anatomical point where the posterior sheath of the rectus muscle ends?

arcuate line

The lack of normal fixation of the testis to the posterior scrotal wall is referred to as:

bell-clapper deformity

Enlargement of the prostate in older men is most often caused by:

benign prostatic hypertrophy

What is the most common prostate condition in a male over the age of 50?

benign prostatic hypertrophy (BPH)

The most common location of a hydrocele is:

between the two layers of the tunica vaginalis

The prostate is situated in the retroperitoneum and is bordered superiorly by the:

bladder

Male infertility can result form what 3 diseases?

blocked seminal vesicles, prostatitis, prostatic lesion

A 52-year-old man presents with hydronephrosis and asymmetric prostate enlargement. This is most likely consistent with:

carcinoma

Elevated PSA is found in patients with:

carcinoma

The ejaculatory ducts pass through the ______ and empties into the urethra.

central zone

Which tumor corresponds to an elevated HCG n malse?

choricarcinoma

What is a hydrocele?

collection of serous fluid within the tunica vaginalis

What are varicoceles?

dilated, tortuous veins of the pampiniform plexus

What are extratesticular findings associated with torsion?

enlarged epididymis, skin thickening, reactive hydrocele

A hydrocele is secondary to:

epididymitis

What zone of the prostate is not affected by cancer and why?

fibromuscular stroma as it is a non-glandular, anterior portion of the prostate

How many lobe is the prostate divided into?

five

What is the sonographic appearance of a hydrocele?

fluid collection surrounding the testicle with possible low-level echoes of fibrin or cholesterol crystals

What PSA levels indicates a strong suspicion for cancer?

greater than 20ng/mL

What does the epididymis consist of?

head, body, tail

What is above the arcuate line?

hematomas are confined within the anterior and posterior rectus sheath

What is below the arcuate line?

hematomas protrude posteriorly into the pelvis due to the absence of the posterior rectus sheath

A simple fluid collection surrounding the testis is referred to as a:

hydrocele

What is the sonographic appearance of the testicular mediastinum?

hyperechoic

What is the most common sonographic appearance of a seminoma?

hypoechoic

What is the classic appearance of prostate cancer?

hypoechoic, peripherally-oriented lesion

Transverse images at the base of the prostate are used to:

image seminal vesicles

What is the cause of varicoceles?

incompetent valves in the internal spermatic vein

The apex of the prostate is the ______ portion of the gland.

inferior

If the physician's request is for evaluation of cryptorchidism, the sonorapher should pay particular attention to which area?

inguinal canal

What are 4 characteristics of a testicular appendage torsion?

intratesticular flow, small hyperechoic mass adjacent to the testis, reactive hydrocele, scrotal wall thickening

Where do varicoceles most commonly appear?

left side as the left gonadal veins drains into the left renal vein

The most common location of a varicocele is:

left side of the scrotum

What are three characteristics of primary varicoceles?

left side, infertility, palpable extratesticular mass

Normal testicular artery flow is considered:

low resistive with broad systolic peaks

The term cryptorchidism denotes:

one or both of the testicles has not descended into the scrotum

What four factors are associated with the increase of PSA in the blood?

patient age, prostate volume, benign prostatic hyperplasia, prostate cancer

Carcinoma of the prostate is most often found in the:

peripheral zone

The most common location of prostatic cancer is the:

peripheral zone

What zone is the source of most prostate cancers?

peripheral zone

Name the four zones of the prostate.

peripheral, transition, central, fibromuscular stroma

The seminal vesicles are located:

posterior to the bladder and superior to the prostate

What ultrasound settings will help evaluate color flow in the testicles?

power Doppler, higher frequency, lowest fileters

What is the most common cancer found in men?

prostate cancer

A male patient present sonographically with a hypervascular noncompressible mass noted in the peripheral zone and ejaculatory ducts filled with calculi. The most likely diagnosis is:

prostatis

The prostate is situated in the retroperitoneum and is bordered anteriorly by the:

pubic bone

The prostate is situated in the retroperitoneum and is bordered posteriorly by the:

rectum

Spermatogenesis occurs within the:

seminiferous tubules

A 30-year-old presents with unilateral testicular enlargement and no pain. This is characteristic of which disease?

seminoma

The most common germ cell tumor of the testis is the:

seminoma

What is a spermatocele? (3)

simple cyst, found within the head of the epididymis, may contain debris

How does the appendix epididmis appear sonographically?

small stalk projecting off the epididymis

The exocrine function of the testicles is to produce:

sperm

A common cyst most often seen in the head of the epididymis that contains nonviable sperm is the:

spermatocele

The base of the prostate is the ______ portion of the gland.

superior

Seminal vesicles are two sac-like out-pouchings of the vas deferens situated adjacent to the ______ and ______ aspect of the prostate between the urinary bladder and rectum.

superior, posterior

The demarcation between the inner gland and the outer gland is called the:

surgical capsule

Which intratesticular tumor is more prevalent in the pediatric age group?

teratoma

What are the sonographic findings associated with torsion of the spermatic cord?

testicle becomes enlarged, inhomogenous, and hypoechoic

Acute onset of testicular pain at rest is a common clinical finding with:

testicular torsion

Visceral layer of the tunica vaginalis covers:

testis and epididymis

The endocrine function of the testicles is to produce:

testosterone

Parietal layer of the tunica vaginalis lines:

the walls of the scrotal chamber with a small amount of fluid

A patient presents with acute scrotal pain and unilateral enlargement. A sonographic examination is performed and the testicular parenchyma is hypoechoic with decreased vascular flow. This is consistent with:

torsion

A 7-year-old boy presents to the emergency department with acute testicular pain localized to the superior pole of his right testis. What is the most likely diagnosis?

torsion of the testicular appendage

The blue dot sign is indicative of:

torsion of the testicular appendage

What are the two most common causes of acute scrotal pain?

torsion, epididymo-orchitis

Benign prostatic hypertrophy (BPH) usually occurs in what zone?

transitional

The most common location of benign prostatic hypertrophy is the:

transitional zone

The prostate is situated in the retroperitoneum and is bordered inferiorly by the:

urogeital diaphragm

Which technique is useful at providing sonographic evidence of a varicocele?

valsalva maneuver

A dilated group of veins found within the scrotum is defined as:

varicocele

What is the most common correctable cause of male infertility?

varicocele

What scrotal abnormality is caused by incompetent valves within the pampiniform plexus?

varicocele

Hydrocele fluid is located between which two layers:

visceral and parieta tunica vaginalis