Ch 5a (normal prostate) Flashcards by Sarah Anderson

What is the ejaculatory duct?

-Duct that passes through central zone + empties into urethra
-Originates from confluence of vas deferens + seminal vesicle

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What is the prostate?

-Accessory gland of male reproduction system
-Muscle driven mechanical switch b/w urination + ejaculation

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What are seminal vesicles?

-Paired simple tubular glands that extend from an out pouching of the vas deferens
-Lie obliquely + caudally to prostate

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Where are seminal vesicles located?

-Superior + posterior to prostate
-B/w urinary bladder + rectum

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What are vas deferens (aka ductus deferens)?

Reproductive duct that extends from epididymis to ejaculatory duct

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What is the verumontanum?

Longitudinal ridge of tissue on posterior prosthetic urethral wall where the orifices of ejaculatory ducts are located

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What ducts are responsible for development of male reproductive system?

Mesonephric ducts

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What will the mesonephric ducts develop into in males?

Portion of each duct develops into an:
-ejaculatory duct
-vas deferens
-seminal vesicle

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Where does the prostate form from?

Urogenital sinus

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What shape is the prostate?

Funnel-shaped exocrine gland surrounded by a fibromuscular capsule

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How much does the prostate weigh?

Approx 20-25 grams

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Measurement of prostate?

4 x 3 x 2 cm

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What does the prostate surround?

Proximal male urethra

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What is the cephalic + caudal parts of the prostate called?

Cephalic: the base (continuous with bladder neck)
Caudal: the apex (adherent to urogenital diaphragm)

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Why would we use a TA u/s to assess the prostate?

Used to get volume estimate (transrectal u/s used for more detailed assessment)

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What 3 structures pass through the prostate?

-2 ejaculatory ducts
-urethra

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The prostatic urethra passes through which portion of the gland?

Central portion

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What 2 structures form the ejaculatory duct at the prostate base?

-duct of seminal vesicle
-ampullae of vas deferens

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The ejaculatory duct joins what structure in the midline of the central zone?

Joins the urethra at the verumontanum

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What is a utricle?

Small epithelium lined diverticulum at apex of verumontanum (fetal remnant of urogenital sinus)

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What appearance does the utricle have on TRV images of the prostate?

Eiffel Tower appearance

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What arteries supply prostate with blood?

Internal iliac arteries

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The internal iliac arteries bifurcate into what arteries?

-prostatic artery
-inferior vesicle artery

Then further branch into:
-urethral artery
-capsular arteries

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What does the venous drainage contain?

Prostatic venous plexus b/w facial layer + capsule

(drains blood from prostate into the internal iliac veins)

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What structure is the primary anatomic reference point in the prostate?

Urethra: divides it into an anterior fibromuscular part + posterior glandular part

4 zones of prostate?

-peripheral (70%) -central (25%) -transition (5%) -periurethral (less than 1%)

What type of tissue accounts for two-thirds of the prostate + contains the 4 zones?

Glandular tissue

Where is the peripheral zone located?

Along posterior, lateral + apical aspects of gland

Which zone is the largest?

Peripheral

M/c location for carcinomas + prostatitis to occur?

Peripheral zone (70% of prostate cancers arise here)

SF of the peripheral zone?

-homogeneous -isoechoic

How can the peripheral + central zones be delineated?

By a thin hyperechoic band separating the 2 zones called the surgical capsule (shaped like a semicircle)

Where is central zone located?

-Base of prostate -Surrounds ejaculatory ducts -B/w peripheral + transition zone

Is prostate cancer commonly found in central zone?

No, 5%

SF of central zone?

More echogenic compared to peripheral zone

M/c zone for benign prostatic hyperplasia (BPH)?

Transition zone

What does the transition zone contain?

2 small lobules lateral to proximal urethral segment

Is cancer common in transition zone?

Kinda, 20%

Normal volume measurement of prostate?

30mL and under

What can the prostate volume go up with BPH?

Can get up to 200mL

SF of transitional zone?

-heterogeneous + more visible

Which zone m/c has calcifications?

Periurethral zone

Location of periurethral zone?

Directly around urethra, embedded in the smooth muscle wall of the urethra

What is the anterior fibromuscular stroma?

-Nonglandular region composed of smooth muscle -Forms anterior portion of prostate

Do seminal vesicles fluctuate in size/shape?

Yes, depending on level of sexual activity (fluid within is anechoic with low level echoes)

SF of vas deferens?

Thick-walled tubular structures

Where does the ampullary of the vas deferens lie in relation to the seminal vesicles?

Adjacent + medially to seminal vesicles

How are ejaculatory ducts formed?

At junction of ampulla of the vas deferens + seminal vesicles

Reasons for a prostate evaluation?

-Abnormal DRE -Differentiation b/w cystic + solid lesions -Abnormal PSA blood test -Check for prostatitis -Evaluate infertility -Guidance during biopsy -Pt has urination/ejaculation symptoms

Does TA imaging of prostate need full or empty bladder?

Full

Does TRUS require a full or empty bladder?

Empty

What pt position is used during a TRUS exam?

LLD with knees toward chest (similar to fetal position)

In SAG where is the base + apex on an image?

Base: left side screen Apex: right side screen

Location of prostate?

B/w urinary bladder + rectal wall (surrounds urethra)

What does the urethra look like on u/s?

Hypoechoic line, dark shadow

Base of prostate is made up of what mostly?

Central zone

At what level of the prostate are the ejaculatory ducts seen?

Central gland

Do calcification's normally occur in the ejaculatory ducts?

Yes

What structures must we always image during a prostate exam?

-seminal vesicles -vas deferens

SF of seminal vesicles + vasa deferentia on u/s?

Seminal vesicles: Lateral + superior to base of prostate. Hypoechoic. Vasa deferentia: B/w seminal vesicles. Thick walled + enter base of prostate.

What 2 groups of blood vessels should be seen on u/s exam?

-periurethral vessels (center of prostate at level of verumontanum) -capsular vessels (penetrates into tissue of gland)