Chapter 17 Flashcards

1
Q

Porstate anteriot relationship

A

Symphysis pubis

Pubic arch

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2
Q

Superior to prostate is

A

Seminal vesicles and bladder

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3
Q

Path of how semen is transported to outside

A
Epididymis
Vas deferens
Join seminal vesicles
Ejaculatory ducts
Urethra
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4
Q

Seminal vesicles

A

2 hollow, sacculated structures
Base bladder
Superior to prostate gland
Inferior to vas deferens and ureters

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5
Q

Prostate size and shape

A

Chestnut shape and size

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6
Q

Base of prostate is

A

Most superior part

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7
Q

Apex is

A

Most inferior part `

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8
Q

Ejaculatory ducts join urehtrea approx

A

Mid way through the prostate

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9
Q

Prostatic urethral divided into

A

Proximal and distal

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10
Q

Ducts

A

Transport seminal fluid

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11
Q

Seminal vesicles adds

A

Secretions to seminal fluid

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12
Q

Prostate adds

A

Secretions to seminal fluid

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13
Q

Urethra

A

Conduit for semen and urine

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14
Q

Prostaticovesical arteries come from

A

Internal illiac artery —> prostatic and inferior vesical artery

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15
Q

Inferior vesical artery supplies

A

The base of the bladder, seminal vesicles and ureter

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16
Q

Prostatic artery branches to

A

Capsular and urethral arteries

Supply prostate

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17
Q

Venous supply of prostate form

A

A network around the sides and base of prostate- deep dorsal penile vein draining into the internal iliac veins

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18
Q

2 regions of prostate gland

A

Fibromuscular region/stroma

Glandular regio

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19
Q

Fibromuscular region/stoma

A

Smaller sction
Anterior to the prostatic urethra
Less clinical significance

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20
Q

Glandular region

A

Posterior portion

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21
Q

Glandular region consists of what 4 zones

A

Peripheral
Central
Transition zone
Periurethral glandular tissue/zone

These zones have differing embryologic origins and susceptibilities to disease

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22
Q

Peripheral zone

A

Largest ~ 70% of glandular tissue
70% of cancers found here
posterior, lateral and apical regions of the prostate
Resembles “eggcup” holding the egg of the central gland

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23
Q

Central zone

A

25% of prostatic glandular tissue
5% of cancer located in Central Zone
Vas deferens and seminal vesicles
-enter at Central zone

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24
Q

Transitional zone

A

lateral aspects of the proximal prostatic urethra
~ 5% of glandular tissue
20 % of cancers
Second most common spot for cancers

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25
Q

Periurethral glandular zone

A

Tissue that lines the proximal prostatic urethra

26
Q

Verumontanum

A

Divides the prostatic urethra

An area close to the centre of the prostate
separates proximal and distal prostatic urethra
Where ejaculatory ducts meet the urethra

27
Q

Prostate problems suspected indicating problem

A

Size
Cancer
Feel lump on rectal exam

28
Q

What lab value increases indicating prostate problem

A

PSA

29
Q

Urinary problems indicating prostate problem

A

Nocturia
Frequency
Weakstream

30
Q

Screening for prostate cancer

A

DRE and PSA blood test

31
Q

PSA lab test

A

Glycoprotein produced exclusively by the prostate
Increase possible prostate cancer exists
Higher the elevation= more likely a cancer exists

32
Q

IF PSA Is NOT IDEAL

A

Normal does not exclude cancer
Elevated doesnt mean cancer
Prostate zie increase causes PSA increase
20 to 40% of men have prostate cancer with normal PSA level

33
Q

PSA ng% levels

A

<2.5 ng% = normal Rumack Curry text book <4 is normal
4-10 ng% = borderline
> 10 ng% = abnormal
Most men at any age have a PSA less than 1.5 ng/mL Normally*

34
Q

PSA

A
provides a continuous index of risk  CA
Higher levels imply higher risk of cancer 
aggressive
Serial PSA Tests
Check if levels change over time
35
Q

PSA density

A

PSA/volume = PSAd
biopsy can detect approx 80% cancer
patients avoid biopsies

marker for prostate cancer aggressiveness
course of action depending on aggressiveness

++ Doctor’s recommend biopsy PSA> 2.5 ng/mL
Suspicious nodule found DRE
Nodule on ultrasound with normal PSA

36
Q

What anatomy is assessed for male pelvis ultrasound

A

Prostate
Seminal vesicles
Bladder

37
Q

Transabdominal male pelvic ultrasound

A

Good for gross prostate and bladder evaluation
Limited to prostate size, shape and weight
Why?
Detail is inadequate
Almost all CA is posterior aspect of prostate not seen transabdominally
Need to evaluate Prostate Better
TRUS

38
Q

Prostate gland procedure for US

A

Prostate gland can be imaged through the full bladder
Crude assessment of prostatic size

Patient drinks 20 to 32 oz water
Use a 3.5 to 5Mhz transducer
Scan with patient in supine position
2 planes

39
Q

Protocol for prostate and seminal vessicle images

A
Transverse and Sagittal images
prostate and seminal vesicles in both planes
Prostate volume L x W x AP  x O.523
Bladder 
prevoid and postvoid volumes
Image RLQ and LLQ in sagittal
40
Q

US of prostate limited to

A

Size shape and weight/volume of prostate

Evaluate bladder too

41
Q

Normal prostate size

A

Weight = 20 grams
Approx. 4 cm (wide)x 3 cm (AP)x 3.8 cm (length)
Volume x 0.523= 23.8cc

42
Q

Sonographic appearance of seminal vesicles

A

In the transverse plane Rt and Lt are seen
Should be symmetric
In sagittal plane they are ovoid structures
Prostate
Heterogenous
Should be symmetrical in shape and size

43
Q

Major reasons to do TRUS

A

Prostate cancer evaluation
Biopsy
Guidance of therapeutic procedures

44
Q

Less common reasons to do TRUS

A

Infertility
Prostatitis
Biopsy any accessible lesion in the pelvis for both men and women

45
Q

Sonographers role for TRUS

A
Explain procedure to patient
What will happen,  list the steps
Empty bladder 
Allow see prostate well
Do you have any questions?
Obtain Verbal consent
If with biopsy will also need signed consent form and potential complications explained
46
Q

Patient position for TRUS

A

Left lateral decubitus with legs together and bent up

Digital rectal exam before probe insertion if performed by Radiologist

47
Q

Equipment for TRUS

A

Transrectal probe 7 to 11 MHz
Increased frequency= resolution
Biopsy gun

48
Q

TRUS orientation of probe

A

Transverse or Axial
Anterior abdominal wall is top of screen with right side of patient on left side of image
Sagittal
Anterior abdominal wall top of screen, head of patient on the left of image – foot at right of image

49
Q

TRUS scan planes

A

Transverse plane (axial)
Seminal vesicles at the base to urethra at the apex
Sagittal plane (90 degree turn)
From right to midline to left lobe

First in gray scale than using Doppler flow imaging in transverse plane for vascular symmetry

50
Q

Prostate anatomy seen on TRUS

A

Better Resolution
Not able to distinguish the 4 zones
zones have similar echotexture

Divide Prostate anatomy into only 2
Inner gland = transitional+ anterior fibromuscular stroma glandular tissue+ internal urethra sphincter
Outer gland = (peripheral zone + central zone)

51
Q

Prostate sonographic appearance

A

Outer Gland (sometimes referred to as peripheral)
uniform, homogenous texture
Slightly more echogenic than inner gland
Inner Gland (sometimes referred to as central)
More hypoechoic
heterogeneous

52
Q

Prostate volume measurement

A

L x AP x W x 0.523

53
Q

Surgical capsule seperates

A

Inner and outer gland

Not always seen in young males

54
Q

Surgical capsule is not

A

A true capsule

55
Q

Appearnce exterior of prostate gland

A

Outer Margin of the prostate “Prostate Capsule”
Not a True Membranous capsule
Clear interface between prostate and periprostatic fat
Exception posterolateral margin appears ragged

56
Q

Prostate vascularity

A

Colour Doppler
Appears mildly to moderately vascular
symmetry

57
Q

sonographic appeance of seminal vesical and vas deferens

A

Seminal vesicles
relatively hypoechoic, multiseptated structures

Vas deferens
Seen adjacent to Seminal vesicles

58
Q

Normal vairants of prostate

A

Benign ductual ectasia
Prostatic calcifications and corpora amylacea
Corpora amylacea

59
Q

Benign duuctal ectasia

A

Older men
Caused by atrophy and dilatation of prostatic ducts
Visible as single or grouped, 1 to 2mm diameter tubular structures in the peripheral zone

60
Q

Prostatic calcifications and corpora amylacea

A

Normal findings
More common with advancing age
Bright echogenic foci or clumps in prostate

61
Q

Corpora Amylacea

A

Proteinaceous debris
sound attenuation preventing TRUS examination
No clinical significance
usually not palpable