Chapter 13: The Male Pelvis Flashcards
a protein produced by the fetal yolk sac, fetal gastrointestinal tract, and the fetal liver; may also be produced by some malignant tumors
alpha-fetoprotein
the testicular appendage located at the head of the epididymis
appendix epididymis
the testicular appendage located between the head of the epididymis and the superior pole of the testis
appendix testis
the testicular appendage located between the body and tail of the epididymis
appendix vas
the condition in which the patient lacks the normal posterior fixation of the testis and epididymis to the scrotal wall
“bell-clapper” deformity
the appearance of a torsed testicular appendage that can be observed as a blue dot just under the skin surface
“blue dot” sign
gland that secretes preejaculate fluid that lubricates the penile urethra prior to ejaculation
bulbourethral gland
Cowper gland
the muscle that raises the testicle
cremaster muscle
the tube that connects the epididymis to the seminal vesicles
ductus (vas) deferens
a coiled structure that is attached to the testicle and the posterior scrotal wall that is responsible for storing sperm
epididymis
inflammation of the epididymis and testis
epididymoorchitis
a type of neoplasm derived from germ cells of the gonads; may be found outside of the reproductive tract
germ cell tumor
hormone produced by the trophoblastic cells of the early placenta; may also be used as a tumor marker in nongravid patients and males
human chorionic gonadotropin (hCG)
a fluid collection within the scrotum; most often found between the two layers of the tunica vaginalis
hydrocele
a condition in which a male has an extra X chromosome; characteristic features include small testicles, infertility, gynecomastia, long legs, and abnormally low intelligence
Klinefelter syndrome
the structure that separates the scrotum into two compartments externally
median raphe
the structure that is formed by the tunica albuginea and contains the rete testis
mediastinum testis
the surgery that moves an undescended testis into the scrotum
orchiopexy
inflammation of the testis or testicles
orchitis
the group of veins in the scrotum
pampiniform plexus
the largest zone of the prostate and most common location for prostatic cancer
peripheral zone
a network of tubules that carry sperm from the seminiferous tubules to the epididymis
rete testis
an extratesticular calculi
scrotal pearl
a fluid that contains secretions from the testicles, seminal vesicles, and prostate gland
semen
small glands located superior to the prostate gland and posterior to the base of the bladder, which secrete an alkaline-based fluid
seminal vesicles
the location of spermatogenesis within the testicles
seminiferous tubules
the most common malignant neoplasm of the testicles
seminoma
the structure that travels through the inguinal canal and contains blood vessels, nerves, lymph nodes, and the cremaster muscle
spermatic cord
a common cyst that is found most often in the head of the epididymis that is composed of nonviable sperm, fat, cellular debris, and lymphocytes
spermatocele
the prostatic zone that is the most common site for benign prostatic hypertrophy
transitional zone
the dense connective tissue that is closely applied to each testicle
tunica albuginea
the structure that separates the scrotum into two separate compartments internally
tunica dartos
the paired serous coatings of the testis; hydroceles are most often found between these two layers
tunica vaginalis
an elevated area within the prostatic urethra at which the ejaculatory ducts meet the urethra
verumontanum
testicles descend into the pelvis at the ___ week of gestation
4th
the testicles descend into the scrotum at __ weeks gestation
28
where does spermatogenesis occur?
within the seminiferous tubules
endocrine function of the testicles
produce testosterone
exocrine function of the testicles
produce sperm
3 parts of the epididymis
head
body
tail
2 roles of the epidiymis
stores sperm in order for them to mature
transports sperm into the ductus (vas) deferens
the ductus (vas) deferens is a tube that connects the epididymis to the _________________
seminal vesicles
the testicles receive most of their blood supply from the what?
testicular arteries
testicular arteries are branches of what?
abdominal aorta
testicular venous drainage is performed by what?
pampiniform plexus
the right testicular vein drains into the _________ and the left testicular vein drains into the _________
IVC
left renal vein
5 components of the spermatic cord
testicular artery pampiniform plexus lymph nodes nerves cremaster muscle
normal scrotal wall thickness
2-8 mm
normal adult testicles measurements
3-5 cm in length
2-4 cm in width
3 cm in thickness
normal epididymis head measurement
10-12 mm
cryptorchidism is found in _____% of full-term births
3-4
an undescended testis will appear ___________ to a normal testis
hypoechoic
Clinical findings:
one or both testicles not palpable within the scrotum
cryptorchidism
Sonographic findings:
testis located outside of the scrotum
the cryptorchid testis will appear hypoechoic to the normal testis
cryptorchidism
ages testicular torsion occurs most often
12-18 years old
testicle salvage rates range from 80-100% if the patient with testicular torsion is treated within _ hours of symptom onset
6
a torsed testicle is usually not salvageable after _ hours
24
Clinical findings:
acute onset of testicular pain (often during sleep)
possible pain within the lower abdomen and inguinal region
swollen testis/scrotum
nausea and vomiting
higher-positioned, painful testis with a horizontal position
acute testicular torsion
Sonographic findings:
enlargement of the spermatic cord, epididymis, and testis
thickened scrotal wall
hypoechoic or heterogeneous testis
reactive hydrocele
no intratesticular flow
decreased intratesticular flow (as compared with the asymptomatic testis)
acute testicular torsion
Sonographic findings:
enlargement of the spermatic cord, epididymis, and testis
no intratesticular flow
hyperemic flow around the testis
heterogeneous testis with areas of necrosis
chronic testicular torsion
most common cause of acute scrotal pain in prepubertal boys
torsion of the appendix testis
3 appendages of the testis
appendix testis
appendix epidiymis
appendix vas
Clinical findings:
acute testicular pain
pain localized to the superior pole of the testis
“blue dot” sign
torsion of the testicular appendage
Sonographic findings: normal intratesticular flow small, avascular, hypoechoic or hyperechoic mass adjacent to the superior pole of the testis reactive hydrocele scrotal wall thickening
torsion of the testicular appendage
Clinical findings:
transilluminates light
painless scrotal swelling
may present with pain when found in the presence of scrotal infections, testicular torsion, trauma, or a tumor
hydrocele
Sonographic findings:
simple fluid anterior to the testis
scrotal wall thickening
chronic hydroceles may have internal debris and septations
hydrocele
spermatoceles are most commonly found where?
head of the epidiymis
Clinical findings:
if large enough, they may be palpable
typically not painful
spermatocele, epidiymal cyst, tunica albuginea cyst
Sonographic findings:
round, anechoic mass with acoustic enhancement
may contain some layering debris
spermatocele, epididymal cyst, tunica albuginea cyst
what do incompetent or abnormal valves within the pampiniform plexus cause?
varicoceles
most common cause of correctable male infertility
varicoceles
cause excess blood within scrotum, extra heat, overheat the sperm
2 types of varicoceles and where they are found
primary - most often found on the left
secondary - found on the right (promptly investigate kidneys and retroperitoneum due to their association with hydronephrosis, hepatomegaly, and retroperitoneal neoplasm)
Clinical findings:
palpable extratesticular mass
possible infertility
varicocele
Sonographic findings:
a group of anechoic, tubular structures located outside of the testis
distended veins that fill with color flow when the Valsalva maneuver is performed
dilated veins that measure greater than 2 mm
possible associated with hydronephrosis, hepatomegaly, or a retroperitoneal neoplasm if found on the right
varicocele
Sonographic findings:
extremely echogenic, mobile extratesticular structure that produces acoustic shadowing
scrotal pearl
most common cause of acute testicular pain in adults
epididymitis
most common cause of epididymitis in young men
chlamydia
Clinical findings: acute testicular pain fever dysuria urethral discharge skin wall edema
epididymitis or epididymoorchitis
Sonographic findings:
enlargement of the entire epididymis (diffuse)
enlargement of only part of the epidiymis (focal)
hypoechoic echotexture of the affected section(s) of the epididymis
hyperemia within the epididymis and/or testis
thickened scrotal wall
epididymitis or epididymoorchitis
what typically causes a testicular abscess?
untreated epididymoorchitis
Clinical findings:
painful, swollen scrotum
fever
elevated white blood cell count
testicular abscess
Sonographic findings:
complex intratesticular mass
mass that has no flow centrally but increased flow around its margins
may have a co-existing pyocele
testicular abscess
Sonographic findings:
complex fluid collection within the scrotum
scrotal wall thickening
may be seen in conjunction with rupture of a testicular abscess
pyocele
_____testicular masses are often considered malignant until proven otherwise, while the majority of _____testicular masses are typically benign
intra
extra
an elevation in _____ levels is found in conjunction with malignant intratesticular tumors 60% of the time
hCG
3 things an elevated AFP level can indicate in a male
embryonal cell carcinoma
adult teratoma
yolk sac tumor
6 germ cell tumors of the testicles
pure seminoma teratoma embryonal cell carcinoma yolk sac tumor choriocarcinoma burned-out germ cell tumor
2 sex cord-stromal tumors of the testicles
Leydig cell tumor
Sertoli cell tumor
the seminoma is a ________ tumor that is typically found in males between __ and __ years of age
germ cell
30
50
Clinical findings:
painless scrotal mass
hardening of the testis
elevated hCG
seminoma
Sonographic findings:
solid, hypoechoic intratesticular mass
seminoma
Clinical findings:
trauma to the scrotum resulting in acute scrotal pain
low hematocrit
scrotal trauma
Sonographic findings:
possible fracture line
indistinct testicular margins
hematocele
scrotal trauma
Clinical findings:
trauma to the pelvis or scrotum
recent pelvic or scrotal surgery
low hematocrit
hematocele
Sonographic findings:
complex fluid collection within the scrotum
scrotal wall thickening
hematocele
Clinical findings:
persistent or intermittent scrotal swelling
may have abdominal pain and blood in stool
inguinal hernia
Sonographic findings:
heterogeneous mass within the scrotum that moves (peristalsis)
mass may contain air and fluid
hydrocele may be present
inguinal hernia
the prostate is a retroperitoneal gland that produces and secretes an ________ fluid that constitutes between __ and __% of the semen
alkaline
13
30
4 zones of the prostate
peripheral zone
central zone
transitional zone
periurethral glandular zone
a protein produced by the prostate
prostate-specific antigen (PSA)
the most common cancer in men
prostate cancer in the form of adenocarcinoma
Clinical findings:
elevated PSA
enlarged prostate
blood in the urine or semen
back pain, pelvic pain, hip or thigh pain
impotence
decrease in the amount of ejaculated fluid
prostate cancer
Sonographic findings:
varying sonographic appearance
hypoechoic mass in prostate
may be hypervascular
prostate cancer
Clinical findings: nocturia increased urinary frequency sense of urinary urgency constant feeling of having a full bladder elevated PSA
benign prostatic hypertrophy
Sonographic findings: enlargement of the inner prostate can lead to hypoechoic areas within the prostate calcifications within the prostate diffusely heterogeneous prostate cystic changes within the prostate
benign prostatic hypertrophy
Secondary varicoceles are associated with all of the following except: A. left-sided location B. right-sided location C. hepatomegaly D. renal mass
left-sided location
The most common location of benign prostatic hypertrophy is the: A. peripheral zone B. transitional zone C. central zone D. verumontanum
transitional zone
Primary varicoceles are associated with all of the following except: A. left-sided location B. retroperitoneal mass C. infertility D. palpable extratesticular mass
retroperitoneal mass
The exocrine function of the testicles is to produce: A. testosterone B. human chorionic gonadotropin C. alpha-fetoprotein D. sperm
sperm
The most common location of a hydrocele is:
A. superior to the testis
B. within the scrotal wall
C. between the two layers of the tunica vaginalis
D. between the tunical vaginalis and tunica albuginea
between the two layers of the tunica vaginalis
Dilated veins of a varicocele will measure:
A. >8 mm
B. >4 mm
C. 2 mm
> 2 mm
The endocrine function of the testicles is to produce: A. testosterone B. human chorionic gonadotropin C. alpha-fetoprotein D. sperm
testosterone
The most common germ cell tumor of the testis is the: A. yolk sac tumor B. embryonal cell carcinoma C. seminoma D. teratoma
seminoma
The most common location of a varicocele is: A. the right side of the scrotum B. the left side of the scrotum C. the inguinal canal D. within the testis
the left side of the scrotum
The most common location of prostatic cancer is the: A. peripheral zone B. transitional zone C. central zone D. verumontanum
peripheral zone
What is the most common sonographic appearance of a seminoma? A. hyperechoic B. anechoic C. heterogeneous with calcifications D. hypoechoic
hypoechoic
