Scrotum & Prostate Flashcards
(140 cards)
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)
2
Q
What is the upper limit of PSA?
A
4ng/mL
3
Q
What regulates prostate growth/function?
A
Testosterone & dihydrotestosterone
4
Q
What does the prostate develop from?
A
from the Wolffian Duct during embryology at week 10 of gestation
5
Q
What 5 lobes make up the prostate?
A
- Anterior
- Middle
- Posterior
- 2 Lateral
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
7
Q
The prostate is ________ to seminal vesicles and bladder.
A
Inferior
8
Q
The prostate is ______ to the rectum.
A
Anterior
9
Q
The prostate is ______ to pubic bone.
A
Posterior
10
Q
The seminal vesicles are _____ to the prostate
A
Superior
11
Q
The seminal vesicles are ______ to the bladder
A
Inferior
12
Q
What is the size of the prostate?
A
3.8 x 4.0 x 3.0 cm
13
Q
What is the sono app of the prostate?
A
Mildly heterogenous with medium level echogenicity
14
Q
How is the prostate visualized most accurately?
A
Transrectally
15
Q
What is the prep for a prostate US?
A
32-40 oz water 1 hr prior to exam
16
Q
What position is transrectal ultrasound done in?
A
Sims
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
18
Q
What are the functions of the scrotum?
A
Containment, protection, heat regulation
19
Q
What is the function of the testicles?
A
Produce sperm
20
Q
What is the purpose of the epididymis?
A
Stores sperm
21
Q
What is the function of the vas deferens?
A
Transports sperm from epididymis to prostatic urethra
22
Q
What is the function of the seminal vesicles?
A
Produce fructose rich fluid
23
Q
How thick should the scrotum tissue be?
A
< 3 mm
24
Q
What is the tunica vaginalis?
A
Extension of peritoneum into the scrotum chambers
25
What does the inner/visceral layer cover?
Testicle and epididymis
26
What does the outer/parietal layer of the tunica vaginalis line?
The scrotal chamber
27
Where do hydroceles form?
In between the inner and outer layers of the tunica vaginalis
28
What is dartos?
A fibrous muscular layer that lies beneath the scrotal skin, separates scrotum into 2 chambers
29
What is the division of the scrotum called?
Scrotal raphe
30
What is contained within the scrotum?
Testes, epididymis, prox vas deferens
31
What is the fibrous capsule surrounding the testicle?
Tunica albuginea
32
What forms the mediastinum testes? What does it do?
Septations from the tunica albuginea, it separates the testicles into lobules
33
The mediastinum extends ______ within the testicle
Longitudinally
34
Where are the seminiferous tubules?
In the wedge shaped compartments formed by the septations from the tunica albuginea
35
What do the seminiferous tubules converge to form?
Tubuli recti
36
Tubuli recti form the _______ when they enter the mediastinum testis
Rete testis
37
What are the rete testis?
A network of tubules at the hilum that carry sperm to efferent ductules
38
What do the efferent ductules do?
Carry seminal fluid from rete testis to epididymis
39
How large is the epididymis?
6-7 cm
40
Where is the epididymis located?
Begins superiorly and travels posterolaterally to testis
41
What segments is the epididymis divided into?
Head, body, tail
42
What is the width of the epididymis head?
6-15 mm
43
How many efferent ductules are in the epididymis? What do they form?
10-15, form the ductus epididymis
44
Where are the seminal vesicles located?
Posterior to bladder and superior to prostate
45
What do the seminal vesicles join with and what does it form?
Vas deferens, together they form ejaculatory duct
46
Where does the ejaculatory duct travel to?
Through the prostate, sperm meets with fluid and empties into prostatic urethra
47
The ductus epididymis becomes the _______ after leaving the epi
Vas deferens
48
What arteries supply the testicles?
- deferential artery
- cremasteric artery
- right and left testicular arteries
49
Where do the right and left testicular arteries originate?
From the abdominal aorta below the RAs
50
What drains the testicles?
Pampiniform plexus
51
What does the right testicular vein drain into? Left?
IVC, left renal vein
52
What are the avg adult testicle measurements?
Sag 3-5 cm
AP 3 cm
Trv 2-4 cm
53
How should testes appear on US?
- homogenous
- low level echoes
- bilaterally isoechoic
- visualization of proper blood flow
54
How should epididymis appear on US?
- isoechoic to each other
- slightly hypo to testes
- head should be largest portion
55
When a varicocele is suspected what technique should be used?
Valsalva
56
What are indications for a scrotal US?
- pain
- enlargement
- palpable mass
- undescended testicles
- follow up of orchiectomy or tumor
- trauma
- male infertility
57
What is BPH?
- benign prostatic hyperplasia
- prostatic glandular tissue keeps growing, >20 mL volume
58
Who is affected by BPH?
Older males
59
What clinical symptoms commonly accompany BPH?
Variety of urinary symptoms
60
What will happen to the appearance of the prostate after having BPH for a long time?
It will develop cystic/anechoic areas due to tissue degeneration
61
What is the sonographic appearance of BPH?
- enlarged
- hypo central part
- echogenic nodules
- compressed CZ & PZ
- calcification, cystic areas
- thickened bladder wall
- hydronephrosis, hydroureter
- **uniform** enlargement
62
If the prostate is asymmetrically enlarged what does that indicate?
Possible malignancy
63
What is prostatitis?
Acute inflammation of the prostate caused by bacterial infection
64
What are the clinical symptoms of prostatitis?
Pain, urinary symptoms, abscess if untreated
65
What is the US appearance of prostatitis?
- can be normal
- diffuse hypo PZ
- hypervascular
- hypoechoic mass
66
How will fluid appear in a patient with prostatitis?
Not anechoic due to pus, bacteria in the fluid
67
What is chronic inflammation of the prostate? Symptoms?
Due to recurrent episodes of prostatitis, symptoms depend on length of inflammation
68
What is the US appearance of chronic inflammation?
- focal masses
- variable echoes
- calcifications
- capsular thickening/irregularity
- not enlarged, shrinking due to tissue dying off
69
Where does carcinoma most commonly develop in the prostate?
Mostly in the PZ and 25% in CZ
70
What are the clinical symptoms of prostate cancer?
- elevated PSA
- urinary symptoms esp hematuria
- back pain
71
What is the US appearance of prostate cancer?
- hypoechoic sm nodules
- isoechoic, hyper, mixed
- irregular margins
- hypervascular
- enlarged prostate
- distended bladder, thick walls, trabeculations
- bilateral hydronephrosis/hydroureter
72
What are normal variants of the testicles?
Polyorchidism: more than 2, unilateral
73
What is cryptorchidism?
- undescended testicles, uni or bilateral
- not located anywhere in scrotum
- can be located anywhere along pathway from retroperitoneum to scrotum
- asymptomatic
74
What is associated with cryptorchidism?
Adult infertility and cancer
75
What is a hydrocele?
- abnormal collection of fluid between inner and outer tunica vaginalis
- congenital or idiopathic
76
What is a hematocele?
- accumulation of blood in scrotal sac
- assoc with trauma or surg intervention
77
What is a pyocele?
Accumulation of pus in scrotal sac, associated with epididymitis/orchitis
78
What differentiates a hydrocele from hematocele/pyocele?
Fluid will be heterogenous because it is not just serous fluid
79
Newer blood is more ______ and older blood is more _______.
Hyperechoic, hypoechoic
80
What is epididymitis? It is the most common cause of _______?
Inflammation of epididymis, most common cause of acute scrotal pain
81
What are the clinical symptoms of epididymitis?
- fever
- pain
- dysuria
- urethral discharge
82
What is the US appearance of epididymitis?
- enlarged, usually at the head
- thickened scrotal skin
- hypoechoic/heterogenous
- can be seen with hydrocele
- increased Doppler compared to contralateral
83
What is orchitis?
Inflammation of testicle, found in 20-30% of epididymitis cases
84
What is the most common cause of orchitis? What are other causes?
- chlamydia
Also:
- mumps
- viral
- idiopathic
85
What are the clinical symptoms of orchitis?
- pain
- fever
- discharge
86
What is the US appearance of orchitis?
Hypoechoic, hypervascular
87
What is spermatic cord torsion? What causes it?
- spermatic cord twists, cuts off blood supply
- caused by Bell & Clapper deformity
88
What does the spermatic cord do?
Keeps all supportive structures in pelvis connected to scrotal contents/testicles
89
What are symptoms of acute torsion?
- extreme scrotal pain, swelling
90
What is the US appearance of acute torsion?
- enlarged testicle & epi head
- decreased echo
- no CF
- twisting/looping of arteries in spermatic cord in inguinal canal
91
What are symptoms of chronic torsion?
Fever, urinary symptoms
92
What is US appearance of chronic torsion?
- small, heterogenous testicle
- no CF
- increased flow in peritesticular tissue
- scrotal wall thickening, hydrocele
93
What is the bell & clapper deformity?
Preexisting abnormality with spermatic cord that makes it easier to twist due to lack of supportive structures
94
What is the chance of saving the testicle after 4-6 hours? 12? 24?
90%, 50%, 10%
95
What is intermittent torsion?
- mobile testicle with recurrent acute scrotal pain and rapid spontaneous resolution
- assoc with B&C
- hydrocele common post torsion
96
What is a partial torsion?
Part of the testicle has a compromised blood flow, compare to other testicle
97
What is the US appearance of partial torsion?
- often missed
- increased blood flow due to reactive hyperemia
98
What is agenesis of seminal vesicle?
Didn’t form, sometimes ipsilateral renal agenesis
99
What is a spermatocele?
- cystic dilation of efferent ductules
- lesion of epididymis containing sperm
- most commonly seen post vasectomy
100
What are the symptoms of a spermatocele?
- painless jaundice
- palpable mass
- onset of diabetes
- weight loss
- abdomen/back pain
101
What is the US appearance of spermatocele?
- epi head
- internal echoes, septations
- smooth walls
102
What is a varicocele? It is the most common cause of?
- enlargement of spermatic cord veins
- majority on left side due to venous drainage into L RV
- most common cause of infertility
103
What are the symptoms of varicocele?
- tender
- palpable mass
- asymptomatic
104
What is the US appearance of varicocele?
- dilated, patent vein
- use valsalva
105
What is the difference between an intratesticular and epidermis cyst?
- intratesticular: serous fluid
- epidermoid: keratin/epithelial tissue
106
Where is an abscess more commonly seen?
Extratesticular
107
What are clinical symptoms of abscess?
Fever, scrotal pain, swelling
108
What is the US app of abscess?
- anechoic or complex mass
- complex due to debris in fluid
- increased peripheral vascularity
- no vascularity in mass
109
What is a scrotal hernia?
- protrusion of bowel through inguinal canal into scrotum
- caused by weakness in abd/pelvic wall
110
What are the symptoms of scrotal hernia?
Groin pain, scrotal pain, difficult defecation
111
What is the US app of scrotal hernia?
- peristalsis/slow moving bowel in scrotum
- free fluid
- valsalva
112
What is a hematoma? Where is it more commonly seen?
- collection of blood commonly caused by trauma or surg intervention
- more common intratesticular
113
What type of tumors of germ cell?
Repro cells
- seminoma
- embryonal/yolk sac
- choriocarcinoma
- teratoma/dermoid
114
What types of tumors are pure tumors?
Germ cell and stromal cell (structural)
115
What tumors are non Germ cell tumors?
- Sertoli cell tumors
- Leydig cell tumors
- mixed/combination
116
What is a Theca cell tumor?
Endocrine cells
117
What cells form an adenoma?
Functional cells
118
What cells form an adenomatoid?
Lining of organ cells
119
What types of tumors are extratesticular?
- adenomatoid
- Leydig tumors
- Sertoli tumors
- cystadenoma
120
What is seminoma?
- most common germ cell tumor
- malignant
- 40-50 yo M
- less aggressive, good prognosis
- palpable lump
121
What is the sono app of seminoma?
- hypo lesion
- smooth/defined borders
122
What is embryonal carcinoma?
- malignant germ cell tumors
- rare, 2-3% of germ cell tumors
- 20-30 yo M
- palpable lump
123
What is the sono app of embryonal carcinoma?
- small hypo areas
- areas of increased echo
- calcifications
- irregular borders
- possible cystic areas
124
What is Yolk Sac tumor?
Infantile version <2 of embryonal carcinoma
125
What is a teratoma?
- malignant germ cell tumor
- contains cells from all 3 germ layers
- aggressive, rare
- painless lump
126
What is the sono app of teratoma?
- well defined, complex mass
- possible calcifications
- often cystic changes
127
What is choriocarcinoma?
- rarest germ cell tumor, rarest testicular cancer
- highly malignant, aggressive
- high levels of b-HCG (pregnancy)
- 25-30 yo
- painless lump
128
What is the sono app of choriocarcinoma?
- irregular borders
- complex lesion
- associated with mets
129
What is the second most common tumor?
Mixed germ cell
130
What is a Leydig cell tumor?
- stromal cell tumor
- usually benign, 10% malignant
- release testosterone
- 20-50 yo m
131
What are the clinical symptoms of Leydig cell tumor?
- gynecomastia
- impotence
- loss of libido
132
What is the sono app of Leydig cell tumor?
- homogenous
- focal areas of hemorrhage/necrosis
- small, solid, hypo
- peripheral flow
133
What is a Sertoli tumor?
- stromal cell tumor
- 10% malignant
- rare <1%
- men of all ages
134
What are clinical symptoms of Sertoli tumors? US app?
- painless lump
- feminization
- gynecomastia
- small, hypo
135
What is a granulosa tumor?
- stromal cell
- juvenile typically benign
- adult typically malignant w mets
- develops from embryonic sex cord
136
What are the symptoms of granulosa tumor?
- painless lump
- gynecomastia
137
What is a theca cell tumor?
- theca cells produce androgen
- rare in testicles, more common in ovaries
138
Lymphoma and testicles
- enlarged testes
- diffuse or focal hypoecho
- weight loss, weakness
- men over 60
139
What order will sperm travel for expulsion?
Seminiferous tubules, tubuli recti, rete testes, efferent ducutules, ductus epididymis, vas deferens
140
Which tumors can produce enlarged male breasts?
Leydig, Sertoli, granulosa
