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urinary pathology > Male Pelvis Pathology > Flashcards

Male Pelvis Pathology Flashcards

(68 cards)

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1
Q

How many kinds of prostate and SV cysts

A

six categories

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2
Q

Parenchymal degenerative cysts

A

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

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3
Q

Retention Cysts

A

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

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4
Q

Congenital cysts

A

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

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5
Q

Where are congenital abnormalities

A

Common in and around the seminal vesicle and protstate

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6
Q

Utericle cysts

A 
Dilation of prostatic utricle
May be seen with unilateral renal agenesis 
Always midline (small and contained within the prostate, may be large)
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7
Q

Mullerian duct cysts

A

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

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8
Q

Ejaculatory duct cysts

A

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

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9
Q

Prostate abscesses

A

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

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10
Q

Cystic neoplasms

A

Rare
Cystadenoma
Cystadenocarcinoma

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11
Q

Seminal Vesicle cysts are…

A

rare

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

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12
Q

Exophytic cyst

A

Exterior

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13
Q

Prostatitis

A

Chronic pain syndrome

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14
Q

Prostatitis does not mean….

A

Infection, inflammation or protstatic involvement

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15
Q

Prostatitis is

A

Leading cause of urologist visits in men <50-years of age

>50 1. BPH; 2. Cancer: 3. Prostatitis

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16
Q

What are classifications of prostatitis

A

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

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17
Q

cute prostatitis

A

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)

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18
Q

Acute prostatitis treatment

A

IV antibiotics

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19
Q

Acute prostatitis clinical

A

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

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20
Q

What are risk factors for acute prostatitis

A

Surgical intervention like bx , catheterization are risk factors

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21
Q

Acute bacterial prostatitis

A

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

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22
Q

Acute bacterial prostatitis sonographically

A

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

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23
Q

Chronic bacterial prostatitis

A

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

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24
Q

Chronic prostatitis (CP)

A

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

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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 ```

urinary pathology (2 decks)

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