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Flashcards in Male Pelvis Pathology Deck (68)
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1

How many kinds of prostate and SV cysts

six categories

2

Parenchymal degenerative cysts

Most common
Hyperplastic nodules in transition zone
Insignigant unless large and causing obstruction
Unilocular or thinly septated

3

Retention Cysts

Focal
result from duct obstruction
firm and mimic cancerous nodule
surface mostly

4

Congenital cysts

In or close to midline
related to Wolffian or Mullerian ducts
Usually asymptomatic unless infected/large

5

Where are congenital abnormalities

Common in and around the seminal vesicle and protstate

6

Utericle cysts

Dilation of prostatic utricle
May be seen with unilateral renal agenesis
Always midline (small and contained within the prostate, may be large)

7

Mullerian duct cysts

Remnants of paramesonephric duct
Mostly midline an extends from midline
If big, can extend above the prostate
Teardrop shaped pointed towards the verumontanum, can have calcifications

8

Ejaculatory duct cysts

Small
cystic dilatation of ejaculatory ducts from ?obstruction; can also be diverticula of duct; assoc. with infertility; can cause perineal pain in patients

9

Prostate abscesses

Thick, irregular walls, debris contaning cysts resemble abscess
E-Coli
Predisposing factors: Diabetes, instrumentation, immunodeffcny, aspiration TRUS

10

Cystic neoplasms

Rare
Cystadenoma
Cystadenocarcinoma

11

Seminal Vesicle cysts are...

rare
usually solitary, asymptomatic, can aspirate if large, associated with renal anomalies like agenesis and APKD

12

Exophytic cyst

Exterior

13

Prostatitis

Chronic pain syndrome

14

Prostatitis does not mean....

Infection, inflammation or protstatic involvement

15

Prostatitis is

Leading cause of urologist visits in men <50-years of age
>50 1. BPH; 2. Cancer: 3. Prostatitis

16

What are classifications of prostatitis

Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome
Inflammatory

17

cute prostatitis

UTI ,epididymitis /orchitis may cause infection of prostate
Main causative agents are
Proteus,Klebsiella species, Escherichia coli,chlamydia and gonorrhea.
PSA will be high(protien produced by prostate)

18

Acute prostatitis treatment

IV antibiotics

19

Acute prostatitis clinical

Pt presnets with fever, chills,pelvic pain,difficulty in urination or ejaculation
Foul smell in urine / blood in semen

20

What are risk factors for acute prostatitis

Surgical intervention like bx , catheterization are risk factors

21

Acute bacterial prostatitis

least common
Symptoms acute urinary or systemic infection
Infection from gram-negative organisms i.e. E-Coli

22

Acute bacterial prostatitis sonographically

Edema, enlargement, hyperemia, venous engorgement, hypoechoic peripheral halo, patchy echo changes

23

Chronic bacterial prostatitis

Uncommon
Usually have bacterial urinary infection and febrile
E-Coli most often
No ultrasound findings

24

Chronic prostatitis (CP)

Most common form of prostatic inflammation
Difficult to treat
Type A (diag. by leukocytes in prostate secretions, urine, semen) and Type B (no evidence of inflammation)
Type B aka Prostatodynia

25

Sonographic features of chronic prostatitis

normal, or peripheral hypoechoic areas, calcifications, venous congestion, increased arterial flow, bladder neck thickening, hypoechoic prostatic rim, periurethral hypogenicity

26

Asymptomatic inflammatory prostatitis

Men with hx genitourinary pain with histological inflammatory changes
Often increased PSA = bx where they identify these inflammatory cells

27

Granulomatous prostatitis

Idiopathic
often following instrumentation

28

Causes of granulomatous prostatitis

Bacteria ex. TB, histoplasmosis, … and parasites ex. Schistosomiasis, …
North America causes: bacille Calmette-Guerin (BCG)commonly instilled in bladderto treat TCC leaks to prostate

29

what are sonographic findings of granulomatous prostatitis

On ultrasound, in general, inflamed prostates are hypoechoic. Often it has several hypoechoic, hypervascular areas.

30

prostatic abscess

0.5-2.5% of cases with bacterial prostatitis
More prevalent diabetes mellitus & immunosuppressed
Large abscessed can be drained (TRUS)

31

Benign prostatic hyperplasia

Lower urinary tract symptoms
50% men over age 60; 90% men over age 70
Weight normal young=20 g; >50 doubles every 10 years
>40g weight considered enlarged in older men
Might be related to hormone changes? unclear

32

What does BPH look like

Hyperplasia and hypertrophy of fibrousmusucular and glandular
Transition and periutheral zones

33

BPH

Hypertrophy of the transitional zone
Obstruction to flow of urine

34

Signs and symptoms of BPH

Nocturia ,sense of urinary urgency, frequency and constant feeling of having full bladder.
PSA ( protein produced by prostate ) will be high
Sonographically prostate shows diffusely heterogeneous texture, calcifications and cystic changes .
TURP / Hormone is treatment

35

Prostatism and bladder outlet obstruction

can relate to increases in prostate size and muscular tone which = urethral constriction

36

Prostatism and bladder outlet obstruction symptoms

Frequency, nocturia, weal stream, hesitancy intermittence, incomplete emptying, urgency

37

PVR

Post void residual volume

38

Prostatism and bladder outlet

Causes retained urine

39

TRUS

Prostate sonogram or endorectal ultrasound
Examine more detailed prostate and surrounding tissues

40

why are turps done

Relieve urinary obstruction

41

TURP

Enlargement of transition zone (inner gland)
Can exhibit hyperechoic, hypoechoic, isoechoic nodules
More distinct nodular margins than in cancerous (poorly marginated)
Hyperplasia in median lobe (periurethral glandular area) = bulging into the bladder

42

Infertility and transrectal ultrasound

Male solely responsible 20% of the time
TRUS to view ejaculatory ducts

43

Hematospermia

Macroscopic blood in the semen

44

TRUS can show

prostatic calcifications, ejaculatory duct calculi, dilated ejaculatory duct, BPH, dilated seminal vesicles, SV calcifications, ejaculatory duct cysts, prostatitis (in 74-95% of cases of TRUS done for infertility)

45

Prostatic calcifications

Normal finding
Bright echogenic foci
can shadow
Will shadow, wide, deep shadow

46

Calcifications of seminal vesicle

Diabetes: tram tracks on wall (-ray)
Infection
Infection/Inflammatory: luminal/segmental; assoc. with SV calcifications

47

Corpora Amylacea

Proteinacious debris in prostatic ducts
Often in periurethral glands
Can be anywhere in prostate
Twinkle on colour Doppler
Possible causes: subclinical infections, inflammation, and atrophy

48

Prostate cancer

Peripheral zone is most common location
Most common cancer in men
Mostly is adenocarcinoma .
Can cause enlarged prostate

49

PSA

Normally occurring enzymes
Excess leakage
Elevated: cancer, BPH, prostatitis, many other causes of elevation

50

Normal PSA

Normal less than 4ng/ml

51

PSA density (more reliable

less than 0.1

52

Grater than 10 PSA

Always sent for bx due to cancerous

53

Age specific PSA

Increases normally with age
40-49-years0.0-2.5 ng/mL
50-59-years0.0-3.5 ng/mL
60-69-years0.0-4.5 ng/mL
70-79-years0.0-6.5 ng/mL

54

PSA _______with age

Increases normally

55

prostate cancer demographic

Mainly men >50-years of age
Long course up to 10-years from asymptomatic to diagnosis

56

Prostate cancer is the most common cancer in

men

57

Treatments for prostate cancer

Varied and personalized

58

Many men have

Mcro-tumors that won't affect longevity

59

Adenocarcinoma

Most common protstae carcinoma
(90%)

60

other prostate cancers

TCC of prostate, sarcomas, lymphomas

61

Prostate can also be affected by

local malignancies from bladder and rectum

62

How does proustite cancer spread

Spread to bones via sacrum

63

Prostate volumes in prostate cancer

Best with TRUS
Age 50-754.0 ng/mL

64

How is prostate cancer graded

T-local tumour
N-Node status
M-Non-lymph node distant Mets

65

Sono appearance of prostate cancer

Varying sonographic appearance
Hypoechoic mass in peripheral zone
May be hyper vascular.
Diagnosis confirmed by trans rectal biopsy.
10 to 12 blind biopsies recommended if PSA is high or PSA density is more than 0.1 even if no suspicious lesion in prostate visible

66

Treatment for prostate cancer

Treatment depends upon Gleason scoring which include only surveillance, or surgery , radiotherapy, hormone therapy, or combined modalities

67

Higher the Gleason score

Lower cure rate

68

TRUS for prostate cancer

Help with diagnosis of Prostate Cancer
Increased PSA levels
Detect abnormal areas on prostate
Needle guidance for TRUS BX
Look at size and shape