Abdominal 3, Prostate/***** Anatomy and Physiology
The corpus spongiosum is
1 unpaired column of erectile tissue on the ventral side of the penis, with the urethra running through the center
What percentage of the volume of semen comes from the prostatic fluid
25-30%
What is the dimensions of the normal prostate
3.8cmL X 4cmW X 3cmH
How much of the volume of the prostate does the anterior fibromuscular stroma make up
5%
Men have a 1 in __ chance of developing, and a 1 in __ chance of dying from prostate cancer
6 30
TRUS can visualize ___ - ___% of prostate cancer
60-70%
The periurethral zone makes up ___% of the prostate gland
<1%
Penile blood pressure (PBI) penile brachial pressure
>.7 - 1.0 normal .6 - .7 borderline abnormal <.6 abnormal
What can the size and shape of the prostate be compared to
A chestnut
What is BPH (Benign prostatic hypertrophy)
A common problem of hyperplasia/hypertrophy of the gland that causes urethral obstruction
What is the anterior Fibromuscular stroma and where is it located
A non-glandular region located anterior to the urethra and extends into the transition zone
What is TURP
A procedure where the resection of the prostate is performed through the urethra (due to cancer or other growths)
What is the ultrasound appearance of the anterior fibromuscular stroma
Anechoic to hypoechoic
How are acute and chronic prostatitis treated
Antibiotics
What is an indication for prostate ultrasound
Assist with biopsy Therapy for cancer Evaluate patients with urinary difficulty Infections Infertility
Where is the apex of the prostate located
At the most inferior portion of the prostate
Where is the base of the prostate located
At the superior portion of the prostate
Anatomically where does the prostate lie
Between the symphysis pubs and rectum Surrounds the proximal urethra (just inferior to the bladder)
The arterial blood to the penis is supplied by
Bilateral penile arteries - a branch of the internal pudendal from the internal iliac arteries
What is hematospermia
Blood in seminal fluid Usually isn't dangerous and resolves on its own
The penis is not often scanned but we may have to do _____ _______ and _______ ______ for impotence We may also scan for _____ or _____ and Evaluate for _______ disease
Blood pressures Doppler readings Masses or lumps Peyronie's
What is the location and percent of the area of the central zone
Borders the seminal vesicles The Vas deferens and seminal vesicles enter and ejaculatory duct passes through 25% of the gland
What is the sonographic appearance of corpora amylecea
Bright echogenic foci or areas in the prostate Can make visualization difficult due to shadowing
What develops in the periruethral zone secondary to reflux of urine into the ducts
Calculi
What zone is most resistant to disease
Central
What zone is relatively resistant to disease
Central
What are the symptoms of ejaculatory duct cysts
Common Asymptomatic unless enlarged Large cysts - Perineal pain Dysuria Hematospermia Ejaculatory pain
The penis is composed of 3 columns of spongy tissue
Corpora cavernosa Corpus spongiosum
How is prostate cancer treated
Depends on age, tolerance to treatment, expected life span and stage of disease Radiation Prostatectomy Orchiectomy (to reduce androgen production) Hormone therapy (Chemotherapy usually ineffective)
What are the most useful methods for detection of prostate cancer
Digital rectal exam PSA screening
What is benign ducal ectasia
Dilation of the peripheral prostatic ducts No clinical significance
What is the venous return from the penis
Dorsal and deep dorsal vein, to the internal pudendal vein to the internal iliac vein
There are 2 main branches of the penile arteries
Dorsal artery Cavernosa arteries - travel through corpus cavernosum
What is the echogenicity of the urethra within the periruethral tissue
Echogenic
Where is the periruethral zone located
Embedded in the smooth muscle wall of the urethra
What is the definition of infertility
Failure to achieve pregnancy after one year of regular unprotected intercourse, affecting 15% of couples
What are the symptoms of acute prostatitis
Fever Chills Low back pain Perineal fullness
What are the symptoms of prostatic abscess
Fever Tender on exam
What is the primary role of ultrasound for the prostate
Guidance for biopsy
What is the secondary role of ultrasound for the prostate
Guidance for therapy
What do the muscles of the prostate do
Help squeeze out prostatic secretion into urethra during ejaculation
What is the sonographic appearance of chronic prostatitis
Heterogeneous echo pattern Increased areas of echogenicity with shadowing (calcifications) Enlarged seminal vesicles Enlarged periprostatic venous plexus Thickened bladder neck
What is the cause of BPH
Hormone imbalance of androgen and estrogen inflammation, neoplasm, arteriosclerosis, nutritional disturbance
Most prostate cancers are _______ to some extent
Hypoechoic
What is the echogenicity of the periruethral tissue
Hypoechoic
What is the echogenicity of the seminal vesicles
Hypoechoic
What is the sonographic appearance of benign ducal ectasia
Hypoechoic Can be mistaken for cancer
What is the sonographic appearance of acute prostatitis
Hypoechoic or anechoic mass within prostate "Cystic appearing" with thick walls and septations
What is the echogenicity of the zones of the prostate
Hypoechoic to isoechoic
When does the prostate develop in gestation
In the 3rd month
What are the clinical findings of BPH
Increased "pressure" to urinate with reduced stream Unable to empty Frequent small urinations UTI Hematuria, proteinuria or bacteriuria
What is the location of the Periurethral glandular zone
It is the tissue that lines the proximal prostatic urethra and also contained in the inner portion of the gland (Anterior Fibromuscular stroma and Internal urethral sphincter)
What does the prostate have to do with urination
It prevents the flow of urine during ejaculation
Where is the Verumontanum located
Just inferiorly to the transition zone
What is the location and percent of the area of the peripheral zone
Lateral and posterior to the distal prostatic urethra Largest zone - 70% of the gland
What is the location of the transitional zone
Lateral to the urethra
What is the cause of prostatic abscess
May be a sequel to prostatitis
What is the sonographic appearance of seminal vesicles cysts and ejaculatory cysts
Meets criteria for simple cyst Sem Ves - are within the gland Ejac duct - are lateral to midline at the base of the prostate
What are the symptoms of prostate cancer
Mostly asymptomatic Elevated PSA Advanced stage - Urinary frequency Urgency Weak stream Occasionally Hematuria
The corpora cavernosa is 2 paired erectile tissues on the dorsal side of the penis and is made up of
Multiple sinusoidal spaces with smooth muscle in the walls
Sonographic appearance of prostate cancer
Only visualized with TRUS Hypoechoic area in the peripheral zone Suspicious contour or echogenicity Ultrasound guided biopsy performed Can invade the bladder
Sonographic findings of BPH
Overall enlargement of the gland Homogenous 1/3 have hypoechoic nodules or echogenic areas/calcification May have cystic changes in the central zone Pre and post void may have some increased residual volume
What are the serum tests to evaluate function of the prostate
PSA (prostatic specific antigen); Normal level = <4mg/ml PSA density (PSA/volume of prostate) LxWxHx0.523; >.12-.15 abnormal PSA velocity (increase of PSA in 1 year); >20% = indication for biopsy
What zone of the prostate is the largest of the glandular zones
Peripheral
What zone of the prostate is the most common site for cancer
Peripheral
What are the outer (peripheral) zones of the prostate called
Peripheral zone Central zone
What is the most commonly diagnosed cancer in men
Prostate cancer
What is the enzyme that liquefies semen and the levels can be measured in the blood as a screening tool for prostate cancer
Prostate-specific antigen (PSA)
The prostate artery is a branch of the
Prostaticovesical artery from the internal iliac artery
What is corpora amylecea
Proteinaceous debris in dilated ducts
Chronic prostatitis is the most common cause of
Recurrent UTI
What are the symptoms of chronic prostatitis
Same as acute but to lesser degree May have hematospermia, dysuria, urgency
What are the sonographic findings of prostatic abscess
Seen as mixed hypoechoic area with possible debris seen
How is BPH treated conservatively
Seitz baths Prostate massages Regular ejaculation Alpha-adrenergic blockers to prevent prostate contractions
Infertility can often be detected by
Semen analysis
What is the function of the prostate
Store and secrete fluid
What is the surgical used as a landmark for
Surgeries
How is metastatic disease treated
Surgical removal of the prostate along with seminal vesicles and radical cystectomy, including perivesical fat, urethrectomy and lymph nodes
What is Peyronie's disease
The development of abnormal scar tissue, or plaques, in tissues inside the penis, causing an erection to be bent and may be painful
What separates the peripheral zone from the central and transitional zones
The surgical capsule
Where does BPH (benign prostatic hyperplasia) originate
The transitional zone
Where do the ejaculatory ducts empty into the urethra
They course through the gland to the urethra
What happens when the patient has surgery to remove metastatic cancer
They will become impotent due to damage to the sympathetic and parasympathetic nerves that control erection and ejaculation
How is ultrasound used in infertility in the male
To check for duct obstructions or anomalies
What are the prostatic secretions for
To help with sperm motility and enzymes that clot and liquefy semen
What are the inner zones of the prostate called
Transitional zone Periurethral glandular zone
What is the most common zone for prostate cancer to develop
Transitional zone 70% But it can arise anywhere in the prostate
What type of ultrasound is the prostate gland scanned with
Transrectal (TRUS) but it can be seen transabdominally
What are more aggressive treatments for BPH
Transurethral resection of prostate (TURP); Uses a rectoscope to remove tissue with a wire loop and electric current Foley Catheter (for high risk patients)
What does TURP stand for
Transurethral resection of the prostate
Each column of the penis is encased by a dense fibrous sheath called
Tunica albuginea
What does the surgical capsule look like sonographically
Usually a hypoechoic line (can be echogenic)
What is the cause of hematospermia
Usually a result from prostate inflammation Occasionally due to cancer
What causes chronic prostatitis
Usually bacterial infection from the urethra
What causes acute prostatitis
Usually from E. Coli infection (80%)
Where doe metastatic disease to the prostate come from
Usually from transitional cell carcinoma (epithelial tissue in the urinary tract)
What are the symptoms of seminal vesicles cysts
Young adults May have painful ejaculation Urinary frequency Dysuria Prostatism Infertility if it obstructs the ejaculatory duct