Ch 5a (prostate pathology) Flashcards by Sarah Anderson

Are cysts in male pelvis common?

No, rare

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Symptoms of cysts in male pelvis?

Ranging from urinary retention - perineal pain

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Where would cysts occur in male pelvis?

-prostate
-seminal vesicles
-vas deferens

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Types of cysts that can occur in male pelvis?

-mullerian duct cysts
-utricle systs
-seminal vesicle cysts
-prostatic cysts
-ejaculatory duct cysts
-vas deferen cysts

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What 2 cysts are m/c in male pelvic cysts?

-mullerian duct
-utricle

(discussed together b/c almost identical locations)

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Why do mullerian duct cysts occur?

Failure of regression of mullerian ducts

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SF of mullerian duct cysts?

-anechoic
-may have debris/calcifications

(is a fluid collection left behind when the mullerians disappear)

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Why do utricle cysts occur?

When prostatic utricle is dilated

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SF of utricle cysts?

-smaller than mullerian duct cysts
-may have calcifications
-unilateral renal agnesis can occur with cystic formation in prostate

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Are seminal vesicle cysts common?

No, less than 0.005% of males have them

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Most cases of seminal vesicle cysts are associated with what?

Ipsilateral renal agenesis

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SF of seminal vesicle cysts?

Paramedian anechoic structures

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Can prostatic cysts be congenital or acquired?

Yes
(congenital = retention or inclusion cysts,
acquired = cystic change from BPH)

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SF of retention prostatic cysts?

-small (1-2cm)
-simple
-smooth walled
-completely anechoic

(clinically not significant)

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M/c type of prostatic cyst?

Aquired cystic changes in transition zone due to BPH

(they are m/c because BPH is common)

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SF of prostatic cysts due to BPH?

-occur within hyperplastic nodules
-very small

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Prostatic abscesses are associated with what?

-acute bacterial prostatitis
-diabetic males

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Symptoms of prostatic abscess?

Fever, chills, urinary frequency, urgency, lower back pain, dysuria, hematuria

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SF of prostatic abscess?

-Focal or diffuse complex areas in any part of prostate
-CD or PD may show hyperemic flow

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M/c symptomatic tumor-like condition in males?

BPH - benign prostatic hyperplasia

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What age m/c gets BPH?

Men over 40 y/o, peaks around 60 y/o

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SF of BPH?

-Diffuse nodular enlargement within transition zone of prostate
-Enlarged central gland in anteroposterior direction
-No longer crescent shape, more rounded
-Up to 4x original size of prostate

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Cause of BPH?

Not well understood, related to hormonal changes due to aging process tho

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Symptoms of BPH?

Urinary symptoms! B/c transition zone lies around urethra. Includes:
-frequency
-nocturia
-dribbling
-difficulty starting stream

(causes obstructive process to flow of urine)

Is BPH m/c found on TA or TRUS exam?

TRUS - on men over 40

What is transurethral resection of the prostate (TURP)?

Procedure done to relieve symptoms caused by compression of prostatic urethra Removal of excess tissue creates the TURP defect which is a lg defect at level of bladder

When would we typically encounter prostate calcifications?

Incidentally, usually in urologic practice

Do prostate calcification's usually have symptoms?

Are prostate calcification's common?

Yes, very common

2 groups prostate calcification's are classified into?

-Endogenous -Exogenous

What are endogenous calcifications?

-Calculi found within substance of prostate, from the prostatic fluid -True prostatic stones (meaning pathologies such as BPH or prostatitis can cause this type of calculi)

What are exogenous calcifications?

-Calculi found in urethra -Derived primarily from urine

SF of prostate calcification's ?

-easily identified -occur in parenchyma of gland -range in size -acoustic shadowing -CD artifact

What type of u/s would ejaculatory duct calcification's be best seen?

TRUS - transrectal u/s

Do ejaculatory duct calcification's cause symptoms?

Yes, hematospermia or painful ejaculation (they can be an incidental finding as well if no symptoms occur)

Is prostatitis easy to diagnose?

No, hard to both clinically + sonographically

A clinical diagnosis of prostatitis is made by evaluating what?

Evaluation of expressed prostatic secretion (EPS) for either positive bacterial cultures or inflammatory cells

4 categories of prostatitis?

-acute bacterial -chronic bacterial -chronic abacterial/chronic pelvic pain syndrome (CP/CPPS) -asymptomatic

Symptoms with acute bacterial prostatitis?

Acutely ill with: -fever -severe lower urinary tract symptoms (LUTS)

How is acute bacterial prostatitis easily diagnosed?

Urine test

Symptoms with chronic bacterial prostatitis?

-discomfort in penis, scrotum + perineum -irritative voiding symptoms such as dysuria, urgency + frequency -recurrent UTIs

What is chronic bacterial prostatitis characterized with?

UTIs

What do asymptomatic patients with prostatitis appear to have?

An inflammatory disease

What is CP/CPPS prostatitis?

Inflammation of prostate with unknown etiology/cause

Which type of prostatitis has highest incidence rate?

CP/CPPS has 8x higher rate than bacterial prostatitis

What are the symptoms with CP/CPPS prostatitis?

Same as pt's with bacterial prostatitis

SF of prostatitis?

-hypoechoic halo in periurethral area (m/c)!!! -heterogeneous echo pattern of peripheral gland with capsular thickening + irregularity -calculi may be seen in gland if pt has chronic prostatitis

How common is prostate cancer?

-2nd m/c -5th most aggressive neoplasm among men worldwide

3 main RF's of prostate cancer?

-African descent -Genetic abnormalities -Obesity

Approx 75% of prostate cancers are detected by what?

An abnormal PSA (blood test) - this is the primary test to check for prostate cancer

Does PSA check for anything other than prostate cancer?

Yes, can be elevated with BPH + prostatitis as well

Pt's sent for a TRUS exam to check for prostate cancer present with what?

Either: -bladder outlet obstruction -abnormal PSA level -Abnormal DRE (digital rectum exam)

SF of prostate cancer?

Hypoechoic lesion m/c in peripheral zone (70%) (remember the majority of hypoechoic areas in this zone are a result from a benign cause like inflammation, fibrosis, infarction, etc. Need a biopsy to detect cancer)

U/s guided biopsies of the prostate use what approach?

Endorectal approach

M/c type of anesthesia used with prostate biopsies?

-Periprostatic nerve block (m/c) -Lidocaine gel also used

Why do pt's often need multiple prostate biopsies done?

B/c don't target the right areas in the prostate (often biopsies come back negative due to this), so pt's must have repeat biopsies which is why the cancer can go undiagnosed for a while

How does u/s guidance help during a biopsy?

-help localize a nonpalpable suspicious lesion -assist in staging prostate cancer by obtaining tissue from areas where microscopic ECE (extracapsular extention) is likely present

What does a biopsy needle look like on u/s?

Echogenic linear structure