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Small Parts > Scrotum & Prostate > Flashcards

Scrotum & Prostate Flashcards

1
Q

What does the prostate do?

A
  • Secretes alkaline fluid that provides a mode of transportation for sperm
  • Produces majority of ejaculatory fluid volume
  • Prostatic glandular tissue produces prostate specific antigen (PSA)
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2
Q

What is the upper limit of PSA?

A

4ng/mL

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3
Q

What regulates prostate growth/function?

A

Testosterone & dihydrotestosterone

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4
Q

What does the prostate develop from?

A

from the Wolffian Duct during embryology at week 10 of gestation

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5
Q

What 5 lobes make up the prostate?

A
  • Anterior
  • Middle
  • Posterior
  • 2 Lateral
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6
Q

What are the seminal vesicles? Where are they located?

A
  • Two outpouchings of the vas deferens
  • Between bladder and rectum
  • Superior and posterior to prostate
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7
Q

The prostate is ________ to seminal vesicles and bladder.

A

Inferior

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8
Q

The prostate is ______ to the rectum.

A

Anterior

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9
Q

The prostate is ______ to pubic bone.

A

Posterior

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10
Q

The seminal vesicles are _____ to the prostate

A

Superior

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11
Q

The seminal vesicles are ______ to the bladder

A

Inferior

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12
Q

What is the size of the prostate?

A

3.8 x 4.0 x 3.0 cm

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13
Q

What is the sono app of the prostate?

A

Mildly heterogenous with medium level echogenicity

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14
Q

How is the prostate visualized most accurately?

A

Transrectally

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15
Q

What is the prep for a prostate US?

A

32-40 oz water 1 hr prior to exam

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16
Q

What position is transrectal ultrasound done in?

A

Sims

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17
Q

What are indications for a prostate ultrasound?

A
  • benign prostatic hypertrophy
  • urinary symptoms
  • abnormal lab values
  • abnormal physical examination
  • pain
  • hematospermia
  • oligospermia
  • infertility
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18
Q

What are the functions of the scrotum?

A

Containment, protection, heat regulation

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19
Q

What is the function of the testicles?

A

Produce sperm

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20
Q

What is the purpose of the epididymis?

A

Stores sperm

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21
Q

What is the function of the vas deferens?

A

Transports sperm from epididymis to prostatic urethra

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22
Q

What is the function of the seminal vesicles?

A

Produce fructose rich fluid

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23
Q

How thick should the scrotum tissue be?

A

< 3 mm

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24
Q

What is the tunica vaginalis?

A

Extension of peritoneum into the scrotum chambers

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25
Q

What does the inner/visceral layer cover?

A

Testicle and epididymis

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26
Q

What does the outer/parietal layer of the tunica vaginalis line?

A

The scrotal chamber

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27
Q

Where do hydroceles form?

A

In between the inner and outer layers of the tunica vaginalis

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28
Q

What is dartos?

A

A fibrous muscular layer that lies beneath the scrotal skin, separates scrotum into 2 chambers

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29
Q

What is the division of the scrotum called?

A

Scrotal raphe

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30
Q

What is contained within the scrotum?

A

Testes, epididymis, prox vas deferens

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31
Q

What is the fibrous capsule surrounding the testicle?

A

Tunica albuginea

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32
Q

What forms the mediastinum testes? What does it do?

A

Septations from the tunica albuginea, it separates the testicles into lobules

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33
Q

The mediastinum extends ______ within the testicle

A

Longitudinally

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34
Q

Where are the seminiferous tubules?

A

In the wedge shaped compartments formed by the septations from the tunica albuginea

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35
Q

What do the seminiferous tubules converge to form?

A

Tubuli recti

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36
Q

Tubuli recti form the _______ when they enter the mediastinum testis

A

Rete testis

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37
Q

What are the rete testis?

A

A network of tubules at the hilum that carry sperm to efferent ductules

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38
Q

What do the efferent ductules do?

A

Carry seminal fluid from rete testis to epididymis

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39
Q

How large is the epididymis?

A

6-7 cm

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40
Q

Where is the epididymis located?

A

Begins superiorly and travels posterolaterally to testis

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41
Q

What segments is the epididymis divided into?

A

Head, body, tail

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42
Q

What is the width of the epididymis head?

A

6-15 mm

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43
Q

How many efferent ductules are in the epididymis? What do they form?

A

10-15, form the ductus epididymis

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44
Q

Where are the seminal vesicles located?

A

Posterior to bladder and superior to prostate

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45
Q

What do the seminal vesicles join with and what does it form?

A

Vas deferens, together they form ejaculatory duct

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46
Q

Where does the ejaculatory duct travel to?

A

Through the prostate, sperm meets with fluid and empties into prostatic urethra

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47
Q

The ductus epididymis becomes the _______ after leaving the epi

A

Vas deferens

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48
Q

What arteries supply the testicles?

A
  • deferential artery
  • cremasteric artery
  • right and left testicular arteries
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49
Q

Where do the right and left testicular arteries originate?

A

From the abdominal aorta below the RAs

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50
Q

What drains the testicles?

A

Pampiniform plexus

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51
Q

What does the right testicular vein drain into? Left?

A

IVC, left renal vein

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52
Q

What are the avg adult testicle measurements?

A

Sag 3-5 cm
AP 3 cm
Trv 2-4 cm

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53
Q

How should testes appear on US?

A
  • homogenous
  • low level echoes
  • bilaterally isoechoic
  • visualization of proper blood flow
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54
Q

How should epididymis appear on US?

A
  • isoechoic to each other
  • slightly hypo to testes
  • head should be largest portion
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55
Q

When a varicocele is suspected what technique should be used?

A

Valsalva

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56
Q

What are indications for a scrotal US?

A
  • pain
  • enlargement
  • palpable mass
  • undescended testicles
  • follow up of orchiectomy or tumor
  • trauma
  • male infertility
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57
Q

What is BPH?

A
  • benign prostatic hyperplasia
  • prostatic glandular tissue keeps growing, >20 mL volume
58
Q

Who is affected by BPH?

A

Older males

59
Q

What clinical symptoms commonly accompany BPH?

A

Variety of urinary symptoms

60
Q

What will happen to the appearance of the prostate after having BPH for a long time?

A

It will develop cystic/anechoic areas due to tissue degeneration

61
Q

What is the sonographic appearance of BPH?

A
  • enlarged
  • hypo central part
  • echogenic nodules
  • compressed CZ & PZ
  • calcification, cystic areas
  • thickened bladder wall
  • hydronephrosis, hydroureter
  • uniform enlargement
62
Q

If the prostate is asymmetrically enlarged what does that indicate?

A

Possible malignancy

63
Q

What is prostatitis?

A

Acute inflammation of the prostate caused by bacterial infection

64
Q

What are the clinical symptoms of prostatitis?

A

Pain, urinary symptoms, abscess if untreated

65
Q

What is the US appearance of prostatitis?

A
  • can be normal
  • diffuse hypo PZ
  • hypervascular
  • hypoechoic mass
66
Q

How will fluid appear in a patient with prostatitis?

A

Not anechoic due to pus, bacteria in the fluid

67
Q

What is chronic inflammation of the prostate? Symptoms?

A

Due to recurrent episodes of prostatitis, symptoms depend on length of inflammation

68
Q

What is the US appearance of chronic inflammation?

A
  • focal masses
  • variable echoes
  • calcifications
  • capsular thickening/irregularity
  • not enlarged, shrinking due to tissue dying off
69
Q

Where does carcinoma most commonly develop in the prostate?

A

Mostly in the PZ and 25% in CZ

70
Q

What are the clinical symptoms of prostate cancer?

A
  • elevated PSA
  • urinary symptoms esp hematuria
  • back pain
71
Q

What is the US appearance of prostate cancer?

A
  • hypoechoic sm nodules
  • isoechoic, hyper, mixed
  • irregular margins
  • hypervascular
  • enlarged prostate
  • distended bladder, thick walls, trabeculations
  • bilateral hydronephrosis/hydroureter
72
Q

What are normal variants of the testicles?

A

Polyorchidism: more than 2, unilateral

73
Q

What is cryptorchidism?

A
  • undescended testicles, uni or bilateral
  • not located anywhere in scrotum
  • can be located anywhere along pathway from retroperitoneum to scrotum
  • asymptomatic
74
Q

What is associated with cryptorchidism?

A

Adult infertility and cancer

75
Q

What is a hydrocele?

A
  • abnormal collection of fluid between inner and outer tunica vaginalis
  • congenital or idiopathic
76
Q

What is a hematocele?

A
  • accumulation of blood in scrotal sac
  • assoc with trauma or surg intervention
77
Q

What is a pyocele?

A

Accumulation of pus in scrotal sac, associated with epididymitis/orchitis

78
Q

What differentiates a hydrocele from hematocele/pyocele?

A

Fluid will be heterogenous because it is not just serous fluid

79
Q

Newer blood is more ______ and older blood is more _______.

A

Hyperechoic, hypoechoic

80
Q

What is epididymitis? It is the most common cause of _______?

A

Inflammation of epididymis, most common cause of acute scrotal pain

81
Q

What are the clinical symptoms of epididymitis?

A
  • fever
  • pain
  • dysuria
  • urethral discharge
82
Q

What is the US appearance of epididymitis?

A
  • enlarged, usually at the head
  • thickened scrotal skin
  • hypoechoic/heterogenous
  • can be seen with hydrocele
  • increased Doppler compared to contralateral
83
Q

What is orchitis?

A

Inflammation of testicle, found in 20-30% of epididymitis cases

84
Q

What is the most common cause of orchitis? What are other causes?

A
  • chlamydia
    Also:
  • mumps
  • viral
  • idiopathic
85
Q

What are the clinical symptoms of orchitis?

A
  • pain
  • fever
  • discharge
86
Q

What is the US appearance of orchitis?

A

Hypoechoic, hypervascular

87
Q

What is spermatic cord torsion? What causes it?

A
  • spermatic cord twists, cuts off blood supply
  • caused by Bell & Clapper deformity
88
Q

What does the spermatic cord do?

A

Keeps all supportive structures in pelvis connected to scrotal contents/testicles

89
Q

What are symptoms of acute torsion?

A
  • extreme scrotal pain, swelling
90
Q

What is the US appearance of acute torsion?

A
  • enlarged testicle & epi head
  • decreased echo
  • no CF
  • twisting/looping of arteries in spermatic cord in inguinal canal
91
Q

What are symptoms of chronic torsion?

A

Fever, urinary symptoms

92
Q

What is US appearance of chronic torsion?

A
  • small, heterogenous testicle
  • no CF
  • increased flow in peritesticular tissue
  • scrotal wall thickening, hydrocele
93
Q

What is the bell & clapper deformity?

A

Preexisting abnormality with spermatic cord that makes it easier to twist due to lack of supportive structures

94
Q

What is the chance of saving the testicle after 4-6 hours? 12? 24?

A

90%, 50%, 10%

95
Q

What is intermittent torsion?

A
  • mobile testicle with recurrent acute scrotal pain and rapid spontaneous resolution
  • assoc with B&C
  • hydrocele common post torsion
96
Q

What is a partial torsion?

A

Part of the testicle has a compromised blood flow, compare to other testicle

97
Q

What is the US appearance of partial torsion?

A
  • often missed
  • increased blood flow due to reactive hyperemia
98
Q

What is agenesis of seminal vesicle?

A

Didn’t form, sometimes ipsilateral renal agenesis

99
Q

What is a spermatocele?

A
  • cystic dilation of efferent ductules
  • lesion of epididymis containing sperm
  • most commonly seen post vasectomy
100
Q

What are the symptoms of a spermatocele?

A
  • painless jaundice
  • palpable mass
  • onset of diabetes
  • weight loss
  • abdomen/back pain
101
Q

What is the US appearance of spermatocele?

A
  • epi head
  • internal echoes, septations
  • smooth walls
102
Q

What is a varicocele? It is the most common cause of?

A
  • enlargement of spermatic cord veins
  • majority on left side due to venous drainage into L RV
  • most common cause of infertility
103
Q

What are the symptoms of varicocele?

A
  • tender
  • palpable mass
  • asymptomatic
104
Q

What is the US appearance of varicocele?

A
  • dilated, patent vein
  • use valsalva
105
Q

What is the difference between an intratesticular and epidermis cyst?

A
  • intratesticular: serous fluid
  • epidermoid: keratin/epithelial tissue
106
Q

Where is an abscess more commonly seen?

A

Extratesticular

107
Q

What are clinical symptoms of abscess?

A

Fever, scrotal pain, swelling

108
Q

What is the US app of abscess?

A
  • anechoic or complex mass
  • complex due to debris in fluid
  • increased peripheral vascularity
  • no vascularity in mass
109
Q

What is a scrotal hernia?

A
  • protrusion of bowel through inguinal canal into scrotum
  • caused by weakness in abd/pelvic wall
110
Q

What are the symptoms of scrotal hernia?

A

Groin pain, scrotal pain, difficult defecation

111
Q

What is the US app of scrotal hernia?

A
  • peristalsis/slow moving bowel in scrotum
  • free fluid
  • valsalva
112
Q

What is a hematoma? Where is it more commonly seen?

A
  • collection of blood commonly caused by trauma or surg intervention
  • more common intratesticular
113
Q

What type of tumors of germ cell?

A

Repro cells
- seminoma
- embryonal/yolk sac
- choriocarcinoma
- teratoma/dermoid

114
Q

What types of tumors are pure tumors?

A

Germ cell and stromal cell (structural)

115
Q

What tumors are non Germ cell tumors?

A
  • Sertoli cell tumors
  • Leydig cell tumors
  • mixed/combination
116
Q

What is a Theca cell tumor?

A

Endocrine cells

117
Q

What cells form an adenoma?

A

Functional cells

118
Q

What cells form an adenomatoid?

A

Lining of organ cells

119
Q

What types of tumors are extratesticular?

A
  • adenomatoid
  • Leydig tumors
  • Sertoli tumors
  • cystadenoma
120
Q

What is seminoma?

A
  • most common germ cell tumor
  • malignant
  • 40-50 yo M
  • less aggressive, good prognosis
  • palpable lump
121
Q

What is the sono app of seminoma?

A
  • hypo lesion
  • smooth/defined borders
122
Q

What is embryonal carcinoma?

A
  • malignant germ cell tumors
  • rare, 2-3% of germ cell tumors
  • 20-30 yo M
  • palpable lump
123
Q

What is the sono app of embryonal carcinoma?

A
  • small hypo areas
  • areas of increased echo
  • calcifications
  • irregular borders
  • possible cystic areas
124
Q

What is Yolk Sac tumor?

A

Infantile version <2 of embryonal carcinoma

125
Q

What is a teratoma?

A
  • malignant germ cell tumor
  • contains cells from all 3 germ layers
  • aggressive, rare
  • painless lump
126
Q

What is the sono app of teratoma?

A
  • well defined, complex mass
  • possible calcifications
  • often cystic changes
127
Q

What is choriocarcinoma?

A
  • rarest germ cell tumor, rarest testicular cancer
  • highly malignant, aggressive
  • high levels of b-HCG (pregnancy)
  • 25-30 yo
  • painless lump
128
Q

What is the sono app of choriocarcinoma?

A
  • irregular borders
  • complex lesion
  • associated with mets
129
Q

What is the second most common tumor?

A

Mixed germ cell

130
Q

What is a Leydig cell tumor?

A
  • stromal cell tumor
  • usually benign, 10% malignant
  • release testosterone
  • 20-50 yo m
131
Q

What are the clinical symptoms of Leydig cell tumor?

A
  • gynecomastia
  • impotence
  • loss of libido
132
Q

What is the sono app of Leydig cell tumor?

A
  • homogenous
  • focal areas of hemorrhage/necrosis
  • small, solid, hypo
  • peripheral flow
133
Q

What is a Sertoli tumor?

A
  • stromal cell tumor
  • 10% malignant
  • rare <1%
  • men of all ages
134
Q

What are clinical symptoms of Sertoli tumors? US app?

A
  • painless lump
  • feminization
  • gynecomastia
  • small, hypo
135
Q

What is a granulosa tumor?

A
  • stromal cell
  • juvenile typically benign
  • adult typically malignant w mets
  • develops from embryonic sex cord
136
Q

What are the symptoms of granulosa tumor?

A
  • painless lump
  • gynecomastia
137
Q

What is a theca cell tumor?

A
  • theca cells produce androgen
  • rare in testicles, more common in ovaries
138
Q

Lymphoma and testicles

A
  • enlarged testes
  • diffuse or focal hypoecho
  • weight loss, weakness
  • men over 60
139
Q

What order will sperm travel for expulsion?

A

Seminiferous tubules, tubuli recti, rete testes, efferent ducutules, ductus epididymis, vas deferens

140
Q

Which tumors can produce enlarged male breasts?

A

Leydig, Sertoli, granulosa

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