Abdominopelvic Chapter 20 (Male Pelvis) and Chapter 29 (Scrotum) Review

How common is prostate cancer?

Aside from skin cancer it is the most common cancer in American men. About 1 in 9 will be diagnosed with prostate cancer during his lifetime. About 6 in 10 are 65 or older but rare before age 40.

The ductus deferens are a thicker convoluted continuation of the ductus ________.

Epididymis

The epididymis empties into the

ductus deferens

The seminal vesicles are considered to appear

ovoid structures with low-level echoes superior to prostate gland.

Fluids are carried outside the body through the _____ via the _______ urethra and finally exit through the external urethral orifice.

penis; distal

Each spermatic cord contains

ductus deferens; testicular arteries; venous pampiniform plexus; lymphatics; autonomic nerves, fibers of cremaster muscle.

With age the prostate sometimes ______.

enlarges

The testis contains ____-______ arterial blood flow.

low resistance

What is testicular ectopia?

Cannot be manipulate into the correct path of descent; most common location is superficial inguinal pouch

What does serum prostatic specific antigen (PSA) evaluate?

Glandular Function

The prostate is considered _______ in echo-texture with _____-_______ echoes.

HEterogenous; medium-level

The three parts of the epididymis are:

Head, body, tail

The testes appear _____ in echo texture with ______ -_____ echoes.

Homogenous; medium-level

What kind of transducer would you use to scan the testicles?

Linear 10-14 MHz

The testes produce _____ which is an exocrine function.

Sperm

What is considered normal for the serum prostatic specific antigen (PSA)?

<4.0 ng/mL

Seminal vesicles secrete a viscous fluid rich in ____; which constitutes about ____ % volume of semen.

Fructose; 60%

The tunica vaginalis consists of two layers derived from the perineum, what are they?

Outer Parietal layer; inner visceral layer

What are the zones of the prostate?

Peripheral Zone Central zone Transitional zone Periurethral glandular zone

The prostate also contains _____ muscles that help expel semen during ejaculation.

Smooth

The prostate gland is located immediately

inferior to the bladder.

What do sonographers examine when scanning the penis?

Detection of fibrosis (Peyronie's disease); detection of scar tissue and plaques; evaluation of tumors; penile hematoma; evaluation of periurethral disease; doppler evaluation of vasculogenic impotence

The testicles are classifies as both _______ and ______ glands.

Endocrine; Exocrine

What is the patient prep for a transrectal US exam?

Enema at least 2 hours prior Antibiotic prep per urologist's orders. No blood thinners for 7 days. Normal urine analysis immediately prior.

The prostate is ______ to ________ vascular.

Mildly to moderately

The adult epididymis measures ____ in length.

3.8 cm

The prostate is about ____ in width.

4 cm

The ductus deferens measure about ____ in length.

45 cm

The seminal vesicles are about ____ in length.

5 cm

T/F Transrectal sonogram assists in baseline prostate assessment.

True

The epididymis appear ___- to __________ compared with the normal testicle.

Iso- to hypoechoic

The seminal vesicles, are mostly ______ ovoid structures containing ______-like space.

symmetrical; cyst

Where do the ductus deferens dilate?

terminal portion near seminal vesicles

The epididymis is divided into how many parts?

3

The prostate is about _____ in anteroposterior dimension.

3 cm

The normal adult testicle measures __ to ___ in length.

3 to 5 cm

The prostate is about _______ in length.

3.8 cm

Of the glandular prostate, the transition zone accounts for about ______%.

5%

An average-sized prostate glad in an adult male patient is

walnut sized

What is the scanning technique for the male pelvis?

warm gel; privacy; support; high frequency transducer; clinical history; clean up

Tunica Albuginea extends into posterior wall of testicle and forms the _______ _______ and interlobar septa.

Mediastinum testis

The hyperechoic linear structure found within the testes is the ________ _______.

Mediastinum Testis

The rete testis is located within _________ _______.

Mediastinum testis

The seminal vesicles are <____ in diameter.

1 cm

Between ____% and ___% volume of semen is is made up by the prostate gland and seminal vesicle secretions.

13% 33%

How large is the needle used in an ultrasound guided prostate biopsy?

18-gauge

The normal adult testicle measures ___ to ___ in height.

2 to 3 cm

The normal adult testicle measures ___ to ___ in width.

2 to 3 cm

The septa of medistinum radiate into the testicle and seperates into ____ to ____ lobules.

200 to 300

What frequency should the transrectal probe be?

7-10MHz

The seminal vesicles vary in size and shape, depending on ____ and _____ ______.

Age; sexual activity

What do the prostate gland and the seminal vesicles secrete? What does this secretion do?

Alkaline fluid; contributes to sperm viability

Each lobule contains one to three _______ _______ _______.

Convoluted Seminiferous Tubules

What portion of the penis contains the spongy urethra?

Corpus Spongiosum

What muscle surrounds each testicle and extends into the abdomen over the spermatic cord?

Cremaster Muscle

Internally, the scrotum is divided into two sacs by a septum called ______ or _______ ______.

Dartos or tunica dartos

Normal variants of the testis include cryptorchidism which describes

Failure of testicles to descend into the scrotum.

T/F Rectal cleansing and a rectal enema are not required before a transrectal ultrasound.

False

T/F: The transabdominal approach is the superior approach for scanning the seminal vesicles and prostate.

False

T/F: Anything greater than 5.0 ng/mL of serum prostatic specific antigen raises a red flag depending on the size of the prostate, patient's age, and clinical history.

False, anything over 4.0 ng/mL

T/F The testis are mildy vascular?

False, they are highly vascular

T/F: The semincal vesicles are sac-like sturctures lying in front of the bladder close to the prostate.

False, they lie behind the bladder.

What is semen?

Fluid that consists of sprem and secretions of the prostate, seminal vesicles, and other glands associated with male urogenital tract.

How many different zones it he prostate divided into?

Four

What are the common locations for the undescended testes:

Inguinal canal (80%); external inguinal ring; abdomen

The prostaticovesical arteries arise from the ______ _____ _______ bilaterally.

Internal Iliac Arteries

The outer parietal layer is closely attached to the _______ ________ _______.

Internal spermatic fascia

What is a key benefit of the provided scrotal ultrasound view?

It enables direct right-versus-left testis comparison of echotexture, size, and flow.

When receiving a transrectal ultrasound the patient will lie in a ____ position.

LLD

What does MINT stand for?

M - malformation suggests hernias, varicocele, and torsion I - inflammation recalls epididymitis & epididymoorchitis N - Neoplasms may be virtually painless, but a mass will give them away T - Traumatic lesions - common in contact sports or external causes

what are the associated tests with the male pelvis?

MRI and Prostatic Biopsy

What externally divides the scrotum into lateral portions by a median ridge?

Median Raphe

What are the seminal vesicles?

Paired glands, each encapsulated by connective tissues, that are convoluted, pouch like structures emptying into distal portion of ductus (vas) deferens to form ejaculatory ducts

The neurovascular bundle of the prostate glad courses along the ______ border.

Posterolateral

An increase in serum prostatic specific antigen (PSA) indicates what?

Presence of disease

What does the contraction of the cremaster muscle play a role in?

Regulating temperature of testicles

The convoluted seminiferous tubules are connected to straight tubules which lead to the ____ _____.

Rete Testis

What is the sac of cutaneous tissue that supports the testicles called?

Scrotum

What do sonographers examine for the prostate?

Size and echo texture; prostatitis (infection); detection of masses; evaluation of benign prostatic hypertrophy (BPH); Sonographic correlation of evaluated serum prostatic specific antigen (PSA); Evaluation of postoperative transurethral resection (TURP); Ultrasound-guided biopsies of prostatic lesions

What do sonographers examine for the seminal vesicles?

Size, symmetry, and echo texture; Ruling out presence of cysts or calculi; inflammatory processes

The prostate is considered _______ in size and shape.

Symmetric

The inner visceral layer is closely attached to the ______.

Testicle

What do sonographers examine when scanning the scrotum?

Testicular size; inflammatory processes (epididymitis orchitis); presence and composition of masses; detection of peri testicular fluid collection (hydrocele); evaluation of scrotal trauma; doppler evaluation to rule out testicular torsion; evaluation of scrotal pain; location of undescended testicles

What is cryptorchidism (undescended testicle)?

Testis has not descended into the scrotum and cannot be brought into the scrotum through external manipulation; greater risk for cancer, infertility

The testes produce _____ which is an endocrine function.

Testosterone.

_____ ______ ______ layers contribute to this duct's increased thickness.

Three smooth muscle

What are the ducts lined with?

Transitional epitheliem

Seminal vesicles in the long axis are seen in which scanning plane?

Transverse

T/F A healthy human prostate is larger than a walnut.

True

T/F: Prostate cancer is the second leading cause of cancer death in American men, behind lung cancer. About 1 man in 41 will die of prostate cancer.

True

T/F: Prostatic and seminal secretions are conveyed through numerous ducts to prostatic urethra.

True

T/F Mos men diagnosed with prostate cancer do not die from it. More than 2.9 million men in the US who have been diagnosed are still alive today.

True.

Each testis is covered by dense, white fibrous tissue called _____ ______.

Tunica Albuginea

_____ spermatic cords extend from inguinal canals and internal inguinal rings into the pelvis.

Two

What does the prostate surround just below the urinary bladder?

Urethra

Does transrectal ultrasound assist in guiding prostate biopsy?

Yes

What is Buck's Fascia?

a thick, fibrous loosely applied covering of skin that envelops the penis

The prostate gland is shaped like a ______ with a central core: the _______ ________.

cone; prostatic urethra.

The prostate consists of which of what elements

glandular tissue; non-glandular tissues; fibromuscular stromal tissue

Accurate evaluation of the prostat gland requires an endorectal approach and a ____-_______ transducer (_____ MHz or higher).

high-frequency; 6MHz