Chapter 19: The Male Pelvis

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Ultrasound examinations of male pelvis are indicated for prostate gland:

-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 is the transitional zone?

1 of 4 zones of prostate gland. Only about 5%. Has 2 lobes laterally of proximal prostatic urethra superior to the verumontanum

Common Diagnostic Tests

MRI, Sonography

What is the prostate shaped like?

a cone with a central core (the prostatic urethra)

What is the prostate gland?

a gland surrounding the neck of the bladder in males and releasing prostatic fluid.

The prostate gland is surrounded by?

a thin capsule consisting of dense fibrous tissue and smooth muscle

What does the seminal vesicle secrete?

a viscous fluid rich in fructose

The prostate and seminal vesicles secrete what kind of fluids?

alkaline

What does BPH cause?

incomplete emptying, retention, increased frequency, urgency, nocturia weak stream, straining to void, dribbling, incontinence, hematuria

The apex of the prostate is the?

inferior margin and exit for urethra

The neurovascular bundle of the prostate gland courses along the __________ border.

posterolateral

The anterior fibromuscular stroma is located anterior to the?

prostatic urethra

The prostate gland is divided into right and left lateral lobes by the

prostatic urethra.

The prostatic urethra is divided by the verumontanum into what segments?

proximal and distal

what is the glandular region?

posterior and largest portion of the prostate gland

Ultrasound examinations of male pelvis are indicated for: Seminal Vesicles

- Evaluation of size, symmetry, and echo texture - Ruling out presence of cysts or calculi - Inflammatory processes

How much prostate fluid is in semen?

13% to 33%

Define ejaculatory ducts

2 ducts that course through the prostate gland and empty into the prostatic urethra

The Central Zone is how much percentage of the glandular prostate?

20%

what is the normal measurement of the prostate?

3.8cm in length, 3cm anteroposterior, 4cm wide

The prox and distal segments of the verumontanum form an angle of?

35 degrees

what is the normal measurement of the seminal vesicles?

5cm in length, less than 1cm in diameter

How much seminal vesicle fluid is in semen?

60%

What is the most inferior organ of the male pelvis?

Prostate

Where is most prostatic pathology located?

in the glandular areas

The prostate is best seen using what technique?

Transrectal because of the close proximity of prostate and rectum

Define fibromuscular region

anterior and smallest portion of the prostate gland

where is the fibromuscular region located?

anterior to the prostatic urethra

How much does the prostate weigh?

approx. 20g

What is the verumontanum?

area where ejaculatory ducts join urethra, close to the center of the prostate

The transabdominal method for scanning the prostate is used only to?

assess the size of the glands due to most pathology and zones not being clearly seen

Why does the prostate gland sometimes enlarge with age?

benign changes, infection, malignant tumors, or other causes

What zones cant be individually distinguished?

central zone and transition zone

The seminal vesicles are encapsulated by?

connective tissue

what are the 4 zones of the prostate glandular region?

peripheral, central, transition, and periurethral

Where do the seminal vesicles empty into?

distal portion of the ductus (vas) deferens to form the ejaculatory ducts

What is BPH (benign prostatic hyperplasia)

enlargement of the prostate gland

The prostate gland contains glandular and nonglandular elements that consist of

fibromuscular stroma and the prostatic urethra

What does the prostate fluids do for the sperm?

helps with sperm visibility

What is the prostate gland relative to the seminal vesicles?

hyperechoic

How are periurethral tissues relative to the urethra?

hypoechoic

what is the peripheral zone of the prostate?

largest of all 4 zones of the posterior glandular portion of the prostate gland and occupies the area lateral and posterior to the distal prostatic urethra

Normal serum PSA

less than 4.0 ng/mL

The glandular elements of the prostate gland are anatomically divided and classified into

lobes and zones

Transrectally, the seminal vesicles appear at what echogenicity?

low grey

Only biopsy can rule out ___________

malignancy

The prostatic urethra eventually transitions to the

membranous, also called the sphincteric urethra

what is semen?

mixture of sperm and seminal fluid

What is the levator ani?

muscle that supports the prostate gland laterally

what is the obturator internus muscle?

muscle that supports the prostate gland laterally

what is the periurethral glandular zone?

one of the 4 zones of the glandular portion of the prostate. consists of tissue that lines the proximal prostatic urethra

define ductus (vas) deferens

one of the two muscular tubes, each joining with its corresponding seminal vesicle to form an ejaculatory duct

The __________ zone of the prostate gland is the site of a majority of prostate malignancies.

peripheral

What is the P-zone?

peripheral zone

What zone is more hyperechoic and homogenous in comparison to others?

peripheral zone

what is the prostatic urethra?

portion of urethra that passes through prostate gland

Normal prostate gland should appear?

semilunar near base (superiorly) and rounded near apex (inferiorly) , heterogenous with medium echoes, symmetric

Lab Values

serum prostatic specific antigen

The base of the prostate gland is the?

superior aspect which is in contact with the urinary bladder

Normal seminal vesicles should appear?

symmetric and isoechoic

What is believed about the fluid from the prostate in reproduction?

that it neutralizes the acid environment of the vagina, uterus, and fallopian tubes

Which zones are the most discernable zones of the prostate?

the P-zone and T-zone

The seminal vesicles angle medially to what?

the apex of the bladder

what does the transitional zone border?

the central zone posteriorly and laterally and the fibromuscular tissue anteriorly

What is the prostate separated posteriorly from the rectum by?

the denonvilliers fascia

What courses through the central zone of the prostate?

the ejaculatory ducts

What does the prostate gland lie behind?

the pubic symphysis

What lies posterior to the urinary bladder and just superior to the prostate?

the seminal vesicles

Where is the central zone of the prostate located?

the superior edge bordering the bladder and seminal vesicles

What is the most important function of the male reproductive system?

to produce sperm

What is the T-zone?

transitional zone

What are the seminal vesicles?

two pouch like structures between the bladder and the rectum connected to the prostate that secrete an alkaline viscous fluid rich in fructose that aids to sperm viability

Define Denonvilliers Fascia

two-layered fascia separating the prostate gland from the rectum

An average-sized prostate gland in an adult male patient is __________.

walnut-sized


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