The Male Pelvis Prostate Gland and Seminal Vesicles Sonography: Guided Notes

Prostate Gland: ____________ to the urinary bladder

inferior

Prostate Gland Surrounds the...

proximal urethra

Prostate Gland Lies posterior to the..

symphysis pubis

Prostate Gland: Separated posteriorly from the rectum by two layers of tissue called ______________________ fascia

Denonvilliers

Prostate Gland: Supported laterally by what two things?

obturator internus and levator ani muscles

Seminal Vesicles: ____________ to the urinary bladder

posterior

Seminal Vesicles Superior to the...

prostate

Seminal Vesicles Angle medially toward the ____ of the bladder

apex

Normal size for the Seminal Vesicles length

5.0 cm in length

Normal size for the Prostate length

3.8 cm in length

Prostate (cone shaped): _________: tip of the cone, inferior margin of the prostate

Apex

Prostate (cone shaped): Base: __________ margin of the prostate in contact with the _______ margin of the bladder

superior inferior

Prostate (cone shaped): Central core

prostatic urethra

Prostate (cone shaped): Perforated by the__ ___ which enter the prostate on the posterior margin, coursing obliquely and anteriorly to enter the ___ ___

ejaculatory ducts prostatic urethra

Prostate (cone chaped): Divided into two main parts

Small, anterior fibromuscular region or stroma

Large, posterior glandular region

Prostate (cone shaped): Small, anterior fibromuscular region or stroma is located anterior to the...

prostatic urethra

Prostate (cone shaped): Small, anterior fibromuscular region or stroma is less important due to...

pathology occurring primarily in the glandular region

Prostate (cone shaped): Large, posterior glandular region

Prostate (cone shaped): Large, posterior glandular region is divided into four zones

Peripheral zone

Central zone

Transition zone

Periurethral glandular zone

Peripheral zone: ________, making up approximately __% of the glandular prostate

Largest

70

Peripheral zone: Occupies the area lateral and posterior to the...

distal prostatic urethra

Central zone: _____% of the glandular prostate

20

Central zone: Located at the superior edge bordering the __ and ___

bladder and seminal vesicles

Central zone: __ ___ course through this zone

Ejaculatory ducts

Transition zone: __% of glandular prostate

5

Transition zone: Two lobes situated on the lateral aspects of the proximal

prostatic urethra superior to the _____________________

verumontanum (area close to the center of the prostate that splits proximal and distal)

Transition zone: Borders the central zone ___ and ___ as well as the fibromuscular tissue ___

posteriorly laterally anteriorly

Periurethral glandular zone: Tissue that lines the _____________ prostatic urethra

Proximal (lining of the urethra)

Seminal Vesicles: Paired glands, each encapsulated by __ __

connective tissue

Seminal Vesicles: Convoluted, __________________ structures emptying into the distal portion of the ductus (vas) deferens to form the __ __

pouchlike

ejaculatory ducts

Prostate Physiology: Secretes a...

milky, alkaline fluid that contains enzymes like prostate specific antigen (PSA)

and fibrinolysin, as well as nutrients like citric acid, zinc, and spermine

Prostate Physiology: Constitutes __ - __% of the total volume of semen

13-33%

Prostate Physiology: Semen is fluid that consists of...

sperm and secretions of the prostate, seminal vesicles and other glands associated with the male urogenital tract

Prostate Physiology: Semen fluid helps with... (4)

o Liquefy semen

o neutralize acidic vaginal environment

o Protect and nourish sperm

o Enhance motility and survival

Seminal Vesicles Physiology: Secrete a ______________, alkaline fluid rich in fructose, prostaglandins and various proteins

Viscous

Seminal Vesicles Physiology: Constitutes __ - __% of the total volume of semen

50-80

Seminal Vesicles Physiology: __ fluid helps (4)

o Provide energy for sperm motility

o Provide hormones which trigger smooth muscle contractions in the female reproductive system to help move sperm forward

o Semen Coagulate (thicken) after ejaculation which is critical for semen to remain in the female reproductive tract

o Protect and nourish sperm (This will help it stay stuck)

Seminal Vesicles Physiology: Prostatic and seminal secretions are conveyed through numerous ducts to the__ __

prostatic urethra

Seminal Vesicles Physiology: The

fluids are then carried outside the body through the penis via the__ __ and finally exit through the __ __ __.

distal urethra and external urethral orifice

Sonographic Appearance Prostate: ___ with medium-level echoes

Heterogeneous

Sonographic Appearance Prostate: ___ in shape and size

Symmetric

Sonographic Appearance Prostate: __________________ when compared to the

seminal vesicles

hyperechoic

Sonographic Appearance Prostate: In a normal prostate, the _________ & ________ zones cannot be differentiated from one another

Central and transition

Sonographic Appearance Prostate: The peripheral zone appears ___ and ___

hyperechoic and homogenous

Sonographic Appearance Seminal Vesicles: _______ structures with low-level echoes superior to prostate gland

ovoid

Sonographic Appearance Seminal Vesicles: Low gray, __ structures

hypoechoic

Sonographic Appearance Seminal Vesicles: ___ in size and shape

Symmetric

Sonographic Appearance Seminal Vesicles: When scanning in the transverse plane, the seminal vesicles will be ___________________

elongated

Sonographic Appearance Seminal Vesicles: When scanning in the sagittal plane, the seminal vesicles will be ___________________

Round

The prostate can be evaluated transabdominally through a distended bladder to assess ________ only.

size

Ultrasound examinations of the male pelvis are indicated for: Prostate (9)

• size and echotexture

• Prostatitis (infection)

• Detection of masses • Evaluation of benign prostatic hypertrophy (enlarged prostate) (BPH)

• Sonographic correlation of findings on a digital rectal examination

• Sonographic correlation of evaluated serum prostatic specific antigen (PSA)

• Evaluation of extracapsular spread of prostatic carcinoma

• Evaluation of postoperative transurethral resection (TURP)

• Ultrasound-guided biopsies of prostatic lesions

Ultrasound examinations of the male pelvis are indicated for: • Seminal Vesicles (4)

• Evaluation of size, symmetry , and echotexture

• Ruling out presence of cysts or calculi

• Inflammatory processes

• Congenital anomalies

Lab Values: PSA

Serum prostatic specific antigen

Lab Values: Serum prostatic specific antigen (PSA): Used to evaluate the function of the ___

prostate

Lab Values: Serum prostatic specific antigen (PSA): Normal serum PSA is..

less than 4.0

Associated Diagnostic Imaging Exams - Prostate biopsy

a procedure to remove small tissue samples from the prostate gland to check for signs of prostate cancer. It is performed by a urologist using a thin needle, often guided by an ultrasound probe, to collect samples for laboratory analysis

Lab Values: Serum prostatic specific antigen (PSA): Elevated serum PSA may indicate...

presence of disease but is not specific for carcinoma

Associated Diagnostic Imaging Exams: Magnetic resonance imaging (MRI)

A noninvasive imaging modality that is very useful in identifying soft tissue structures.

Associated Diagnostic Imaging Exams: Sonography

As a method of evaluating the structures of the male genitourinary system, ultrasonography is second only to direct physical palpation of the prostate by a urologist.