Male Pelvis Notes Flashcards
What is the appendix testis?
A small solid structure located posterior to the epididymal head.
What is the central zone (CZ) of the prostate?
A cone-shaped area of the prostate gland located deep in the peripheral zone.
What are the corpus cavernosa?
The two columns of erectile tissue forming the body of the penis.
What is the corpus spongiosum?
The mass of spongy tissue surrounding the urethra.
What is cryptorchidism?
Undescended testis.
What is Denonvilliers’ fascia? This is a important landmark for what?
- Separates the prostate and rectum
- Important landmark for radical prostatectomy.
What is the epididymis?
Long, tightly coiled ducts that carry sperm from the testis to the vas deferens.
What is epididymitis?
Inflammation of the epididymis; commonly caused by a urinary tract infection; most common cause of acute scrotal pain.
What is a hydrocele?
Abnormal accumulation of serous fluid between the two layers of tunica vaginalis.
What is hypospadias?
Urethra opening is located somewhere along the undersurface of the penis.
What is the mediastinum testis?
Thick portion of the tunica albuginea.
What is the peripheral zone (PZ) of the prostate?
The largest area of the prostate gland located just beneath the capsule.
What are periurethral glands?
Glandular tissue lining the proximal prostatic urethra.
What is Peyronie’s disease? What can this lead to?
Fibrous scar tissue most commonly along the dorsal portion of the penis within tunica albuginea that may progress to calcification(s).
What is polyorchidism?
Presence of more than two testes.
What is prostate specific antigen (PSA)?
A protein produced by the prostate; elevation is associated with carcinoma of the prostate gland.
What is orchitis?
Inflammation of the testis; commonly caused by chlamydia.
What is the rete testis?
Network of ducts formed in the mediastinum testis connecting the epididymis with the superior portion of the testis.
What is the space of Retzius?
Retropubic space between the symphysis pubis and urinary bladder.
What is the spermatic cord?
Supporting structure on the posterior border of the testes that courses through the inguinal canal.
What is a spermatocele?
A cyst arising from the rete testis.
What is the surgical capsule?
Hypoechoic connective tissue dividing the peripheral and central zones.
What is testicular torsion?
Twisting of the spermatic cord upon itself, obstructing the blood vessels supplying the epididymis and testis; also known as bell clapper.
What is the transitional zone (TZ) of the prostate?
Two small areas of the prostate gland adjacent to the proximal urethral space.
What is transurethral resection prostatectomy (TURP)?
A surgical procedure to relieve symptoms of benign prostatic hypertrophy; demonstrates as an anechoic space in the center of the prostate.
What is a varicocele? How does this affect fertility of a male?
- Dilatation of the spermatic veins
- Most common cause of male infertility.
What is the vas deferens?
A small tube that transports the sperm from each testis to the prostatic urethra.
What is the verumontanum?
Divides the urethra into proximal and distal segments.
What is the function of the scrotum?
Allows maintenance of a lower body temperature necessary for sperm survival.
What are the functions of the epididymis? 2
- Store and transport sperm produced by the testes
- Mature the sperm.
What are the functions of the testis?
- Produce testosterone
- Germinate sperm.
What are the functions of the prostate gland?
Secretes alkaline fluid to transport sperm; produces 80% to 85% of the ejaculation fluid.
What are the functions of the penis? 2
- Transport urine out of the body
- Male sex organ.
What is the anatomy of the scrotum? How is the scrotum divided?
- A two-compartment pouch that contains and supports each testis
- Divided by a medium raphe or septum.
Where does the epididymis empty into? Where is it located in relation to the testis?
- Empties into the ductus deferens
- Located lateral and posterior to the testis.
What are the testes?
Paired male reproductive organs located in the scrotum; endocrine and exocrine glands.
What is the tunica albuginea?
Fibrous sheath enclosing each testis.
What is the tunica vaginalis?
Two layers of serous membrane covering the anterior and lateral portions of the testis and epididymis.
What is the mediastinum testis?
Thick portion of the tunica albuginea located in the posterior medial border of the testis.
What is the rete testis?
Network of ducts formed in the mediastinum testis that transports seminal fluid from the testis to the epididymis.
What is the spermatic cord?
Support structure located on the posterior border of the testes; courses between the abdominal cavity and scrotum.
What is the prostate gland?
A cone-shaped retroperitoneal structure consisting of five lobes.
The central zone (CZ) of the prostate comprises of how much of the glandular tissue? How does disease affect this portion?
Comprises approximately 25% of the glandular tissue; resistant to disease.
How much does the peripheral zone (PZ) of the prostate comprise of? How resistant is it to disease?
Comprises approximately 70% of the glandular tissue; site for most prostate cancer.
How much does the transitional zone (TZ) of the prostate consist of? What diseases are prevailent here?
- Comprises 5% of the glandular tissue and periurethral glands
- Area where benign prostatic hypertrophy (BPH) originates.
What are the seminal vesicles? 2
- Paired structures lying superior to the prostate
- Stores sperm.
What is the surgical capsule?
Connective tissue separating the peripheral and central zones; surgical boundary line used in transurethral resection procedures.
What is the glans of the penis?
In uncircumcised men, covered with pink, moist tissue called mucosa.
What are the corpus cavernosum?
Two columns of tissue running along the sides of the penis; blood fills this tissue to cause an erection.
What is the corpus spongiosum?
A column of sponge-like tissue running along the front of the penis; the urethra runs through it.
The testicular arteries arise from what? How does it course?
Arise from the anterior aspect of the abdominal aorta and course toward the mediastinum testis.
What does the prostaticovesical arteries arise from? What does it supply?
- Arise from the internal iliac arteries
- Supply the bladder base, seminal vesicles, and the ureter.
What is the arterial supply to the penis? How is it subdivided?
- Through the paired internal pudendal arteries
- Subdivided into a deep cavernosal artery and bulbouretheral artery.
What is cryptorchidism? Where is 80% of these located?
- Undescended testis
- 80% are located in the inguinal canal.
What is polyorchidism? What is this associated with?
- Presence of more than two testes
- Associated with inguinal hernia, testicular torsion, and malignancy.
What is the sonographic appearance of the scrotum? 2
- Thin hyperechoic wall measuring 2 to 8 mm in thickness
- Small amount of anechoic fluid surrounds each testis.
What is the normal size of adult testes?
3 to 5 cm in length, 3 cm in height, and 2 to 4 cm in width.
What is the echo pattern of the testis compared to normal?
Coarser echo pattern compared with the normal testis.
What is the blood flow characteristic in the testis?
Minimal or no discernible internal blood flow.
What is the appearance of the spermatic cord?
Hypoechoic to isoechoic structure superior to the testicles.
How does the spermatic cord appear in sagittal orientation?
Multiple linear strands in sagittal orientation.
What is the shape of the spermatic cord in transverse orientation?
Round or oval in shape.
Describe the echo pattern of the prostate.
Homogeneous structure demonstrating a medium-level echo pattern.
How does the peripheral zone of the prostate appear?
Appears uniform in texture and slightly more echogenic than the central zone.
What separates the peripheral and central zones of the prostate?
Hyperechoic band (surgical capsule).
What do the seminal vesicles look like on ultrasound?
Appear as hypoechoic structures superior to the prostate gland.
How does the verumontanum appear compared to the parenchyma?
Appears hyperechoic compared with the parenchyma.
What is the echo pattern of the corpus spongiosum?
Located in the midline with a homogeneous medium-level echo pattern.
What is the appearance of the corpus cavernosa?
Symmetrical, display a medium-level echo pattern and are located posterior to the corpus spongiosum.
What covers the corpus cavernosa?
Highly echogenic tunica albuginea.
Where are the cavernous arteries located?
Centrally located within the corpus cavernosa.
Is preparation necessary for a sonogram of the scrotum and penis?
No preparation is necessary.
What is the preferred technique for prostate examination?
Transrectal approach.
What is required for transabdominal prostate examination?
Full urinary bladder.
What is required for transrectal prostate examination?
Empty urinary bladder.
What frequency transducer is used for adult scrotum imaging?
7.5 MHz to 12 MHz linear.
What frequency transducer is used for children and small adults?
10 MHz to 15 MHz linear.
What is the transducer frequency for transabdominal prostate imaging?
3 MHz to 5 MHz curvilinear.
What is the transducer frequency for transrectal prostate imaging?
5 MHz to 8 MHz transrectal.
What is the patient positioning for scrotum examination?
Supine with the legs slightly apart and a rolled towel placed under scrotum for support.
What is the patient positioning for transrectal prostate examination?
Left lateral decubitus with knees flexed toward the chest.
What is the examination protocol for scrotum?
Systematic evaluation and bilateral imaging of the head, body, and tail of the epididymis and upper, mid, and lower portions of the testes.
What should be measured during scrotum examination?
Length, height, and width of each testis and epididymis.
What is the examination protocol for prostate?
Angle caudally through the urinary bladder to visualize the prostate.
What should be documented during prostate examination?
Abnormalities of the prostate should be documented and measured in two imaging planes.
What is the examination protocol for penis?
Systematic dorsal, lateral, or ventral approach in the sagittal, coronal, and transverse planes.
What are the image optimization techniques? 3
- Adjust gain settings
- Place focal zones
- Use harmonic imaging.
What are the examination limitations? 2
- Patient cooperation
- Near-field reverberation.
What are the indications for scrotal examination? 6
- Scrotal pain
- Trauma
- Enlarged scrotum
- Palpable mass
- Infertility
- Undescended testis.
What are the indications for prostate examination? 4
- Enlarged prostate
- Changes in urination
- Elevated PSA level
- Infertility.
What are the indications for penis examination? 4
- Vasculogenic impotence
- Painful erection
- Palpable mass
- Trauma.
What is the normal level of prostate specific antigen (PSA)?
Normal monoclonal PSA is 4.0 ng/mL.
What does a PSA level greater than 20 ng/mL indicate?
Indicates a strong likelihood for carcinoma.
What are the clinical findings of a calculus in the scrotum? (s/s) 2
- Asymptomatic
- Palpable scrotal mass.
What are the sonographic findings of a calculus? 3
- Hyperechoic focus
- Mobile
- Round in shape.
What are the clinical findings of epididymitis? 3
- Acute scrotal pain
- Palpable posterior mass
- Leukocytosis.
What are the sonographic findings of epididymitis? 2
- Enlarged hypoechoic epididymis
- Hypervascular epididymis.
What are the clinical findings of testicular torsion? 2 (s/s)
- Sudden onset of groin or scrotal pain
- Nausea/vomiting.
What are the sonographic findings of testicular torsion? 2
- Hypoechoic parenchyma (acute)
- Markedly absent or decreased intratesticular blood flow.
What are the clinical findings of benign prostatic hypertrophy? 3
- Urinary frequency
- Dysuria
- Decreased urinary output.
What are the sonographic findings of benign prostatic hypertrophy? 2
- Symmetrical prostate enlargement
- Hypoechoic parenchyma.
What are the clinical findings of Peyronie’s disease? 2
- Pain with marked curvature of the penis
- Erectile dysfunction.
What are the sonographic findings of Peyronie’s disease? 2
- Focal hyperechoic thickening
- Echogenic plaque or calcifications.
