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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
Periurethral glandular zone
Tissue that lines the proximal prostatic urethra
26
Verumontanum
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
Prostate problems suspected indicating problem
Size Cancer Feel lump on rectal exam
28
What lab value increases indicating prostate problem
PSA
29
Urinary problems indicating prostate problem
Nocturia Frequency Weakstream
30
Screening for prostate cancer
DRE and PSA blood test
31
PSA lab test
Glycoprotein produced exclusively by the prostate Increase possible prostate cancer exists Higher the elevation= more likely a cancer exists
32
IF PSA Is NOT IDEAL
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
PSA ng% levels
<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
PSA
``` 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
PSA density
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
What anatomy is assessed for male pelvis ultrasound
Prostate Seminal vesicles Bladder
37
Transabdominal male pelvic ultrasound
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
Prostate gland procedure for US
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
Protocol for prostate and seminal vessicle images
``` 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
US of prostate limited to
Size shape and weight/volume of prostate Evaluate bladder too
41
Normal prostate size
Weight = 20 grams Approx. 4 cm (wide)x 3 cm (AP)x 3.8 cm (length) Volume x 0.523= 23.8cc
42
Sonographic appearance of seminal vesicles
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
Major reasons to do TRUS
Prostate cancer evaluation Biopsy Guidance of therapeutic procedures
44
Less common reasons to do TRUS
Infertility Prostatitis Biopsy any accessible lesion in the pelvis for both men and women
45
Sonographers role for TRUS
``` 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
Patient position for TRUS
Left lateral decubitus with legs together and bent up | Digital rectal exam before probe insertion if performed by Radiologist
47
Equipment for TRUS
Transrectal probe 7 to 11 MHz Increased frequency= resolution Biopsy gun
48
TRUS orientation of probe
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
TRUS scan planes
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
Prostate anatomy seen on TRUS
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
Prostate sonographic appearance
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
Prostate volume measurement
L x AP x W x 0.523
53
Surgical capsule seperates
Inner and outer gland | Not always seen in young males
54
Surgical capsule is not
A true capsule
55
Appearnce exterior of prostate gland
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
Prostate vascularity
Colour Doppler Appears mildly to moderately vascular symmetry
57
sonographic appeance of seminal vesical and vas deferens
Seminal vesicles relatively hypoechoic, multiseptated structures Vas deferens Seen adjacent to Seminal vesicles
58
Normal vairants of prostate
Benign ductual ectasia Prostatic calcifications and corpora amylacea Corpora amylacea
59
Benign duuctal ectasia
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
Prostatic calcifications and corpora amylacea
Normal findings More common with advancing age Bright echogenic foci or clumps in prostate
61
Corpora Amylacea
Proteinaceous debris sound attenuation preventing TRUS examination No clinical significance usually not palpable

Normal (21 decks)

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