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Prostate
Cancer
A Visual Reference Guide for Patients
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The
Prostate
The prostate is a gland consisting of fibrous, muscular and glandular
tissue surrounding the urethra below the urinary bladder. Its function
is to secrete prostatic fluid as a medium for semen, helping it to
reach the female reproductive tract. Within the prostate, the urethra
is joined by two ejaculatory ducts. During sexual activity, the prostate
acts as a valve between the urinary and reproductive tracts.
This enables semen to ejaculate without mixing with urine.
Prostatic fluid is delivered by the contraction of muscles around
gland tissue. Nerve and hormonal influences control the secretory
and muscular functions of the prostate.
Normal Prostate
Urinary bladder
Ureteral orifice
Trigone
Bladder wall
Seminal
vesicles
Internal
urethral
sphincter
Ejaculatory
ducts
Pubic
symphysis
Prostatic
capsule
Prostatovesicular
junction
Anterior
rectal wall
Prostate
gland
Prostatic
urethra
Prostatic utricle
External urethral
sphincter
Membranous
urethra
Bulbourethral
gland
Deep dorsal
vein of the penis
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Posterior View
Fibromuscular
wall of bladder
Peritoneal covering
over bladder dome
Ductus
deferens
Ureter
Ampulla
of ductus
deferens
Seminal vesicle
Retropubic
space
Levator
ani muscle
The Prostate
Membranous
urethra
Prostatic utricle
Anterior View with Exposed
Prostatic Urethra
Interureteric
fold
Trigone
Orifice
of ureter
Venous
plexus
Muscular
wall of bladder
Urethra in
bladder neck
Openings of
urethral gland
Prostatic utricle
Prostatic sinus
}
Base
Prostatic urethra
Orifice of
ejaculatory duct
Urethral crest
Membranous urethra
Apex
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What is
Prostate Cancer?
Prostate cancer, a malignant growth of cells in the prostate gland,
is the most common cancer in U.S. men. Of all newly diagnosed
cases of cancer in U.S. men, it is estimated that approximately 25%
will be prostate cancer. Mortality rates due to prostate cancer have
declined since 1991. This decrease in death rate suggests greater
public awareness is leading to earlier detection and treatment of
prostate cancer. Although early or local prostate cancer may be
asymptomatic, lumps are detectable upon physical examination.
With disease progression, symptoms occur, including urinary
problems such as painful episodes and the presence of blood.
Metastasis, most commonly to the lymph nodes, lungs and bones
in the hip region, is characteristic of advanced prostate cancer.
Zones of the Prostate
Prostatic
urethra
A
C
B
E
A
E C
B
D
D
Ejaculatory
duct
A Central zone
B Fibromuscular zone
C Transitional zone
D Peripheral zone
E Periurethral gland region
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Prostatic Carcinoma
(Malignant Tumor)
Prostatic carcinoma is the most common malignant tumor in men.
Unlike Benign Prostatic Hyperplasia (BPH), prostate cancer enlarges
the prostate and also metastasizes (spreads) to other parts of the
body through lymphatic and venous channels.
What is Prostate Cancer?
Malignant tumor
(prostatic carcinoma)
Pathways for Prostate Cancer Spread
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Prostate Cancer
Stages
In order to plan treatment, the physician must understand the extent
(stage) of the disease. The stage is based on the size and spread
of the tumor; the higher the stage, the more advanced the cancer.
To determine if the cancer has spread, imaging tests such as a bone
scan, CT scan or MRI may be performed. Recurrent cancer is cancer
that has come back after a period of being undetectable.
Stage 1
The cancer is not found during a digital rectal exam, but found when
doing a biopsy for increased prostate-specific antigen (PSA) or
surgery for another reason. The cancer is located only in the prostate.
Bladder
Cancer
Seminal
vesicle
Prostate
Stage 2
The cancer can be felt on digital rectal exam but has not yet
spread outside the prostate.
Cancer
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The cancer has spread outside the prostate, perhaps to the seminal
vesicles, but not to the lymph nodes.
Prostate Cancer Staging
Stage 3
Cancer
Stage 4
The cancer may have spread to nearby muscles, organs, lymph nodes
or other parts of the body.
Lymph
nodes
Cancer
Pathways of
spreading cancer
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Gleason Pathologic
Scoring System
If cancer is not found, medicine to reduce the symptoms caused
by an enlarged prostate may be suggested. If cancer is found,
the tumor(s) will be graded on the aggressiveness of the disease –
how fast the cancer will grow and spread. One system of grading
is the Gleason Pathologic Scoring System, which ranges from
1 to 5. The two most common histological patterns are added
together to get a Gleason score between 2 and 10. A lower score
indicates a less aggressive cancer, and a higher score indicates
a more aggressive cancer.
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Histological Patterns
Well
Differentiated
Gleason Pathologic Scoring System
1
2
3
4
5
Poorly
Differentiated
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Tests
Diagnostic Tests
Depending on the results of the screening test(s), the physician will
perform additional diagnostic tests, which may include:
• Transrectal ultrasound – A probe is inserted into a man’s rectum to check
for abnormal areas.
• Transrectal biopsy – After a needle is inserted through the rectum to the
prostate, tissue is removed to look for cancer cells.
Screening Tests
Screening refers to testing to find a disease such as cancer in people who do not
have symptoms of that disease. For some types of cancer, screening can help
find cancers in an early stage when they are more easily cured. Prostate cancer
can often be found early by testing the amount of prostate-specific antigen
(PSA) in the blood. Another way to find prostate cancer is the digital rectal
exam (DRE).
• Blood test for Prostate Specific Antigen (PSA) –
Prostate-specific antigen (PSA) is a substance made by cells in the prostate
gland (it is made by normal cells and cancer cells). Although PSA is mostly
found in semen, a small amount is also found in the blood. Most healthy men
have levels under 4 nanograms per milliliter (ng/mL) of blood. The chance
of having prostate cancer goes up as the PSA level goes up. When prostate
cancer develops, the PSA level usually goes above 4. Still, a level below 4
does not mean that cancer isn't present -- about 15% of men with a PSA
below 4 will have prostate cancer on biopsy. Men with a PSA level in the
borderline range between 4 and 10 have about a 25% chance of having
prostate cancer. If the PSA is more than 10, the chance of having prostate
cancer is over 50%.
• Digital rectal exam (DRE) – For a
digital rectal exam (DRE), a doctor
inserts a finger into the rectum to feel
for any bumps or hard areas on the
prostate that might be cancer. The
prostate gland is found just in front
of the rectum, and most cancers
begin in the back part of the gland,
which can be felt during a rectal
exam. This exam is uncomfortable,
but it isn't painful and only takes a
short time.
Digital rectal exam (DRE)
Prostate
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Treatments
There are several ways to treat prostate cancer, and a
combination of treatments may be recommended by the
physician. Treatment depends on a number of factors, such as
the prostate-specific antigen (PSA) level, the Gleason score
which indicates how aggressive the cancer is, the spread
(stage) of the cancer, and the age, the symptoms and the
general health of the patient.
Treatment options include active surveillance, surgery,
radiation therapy, hormone therapy, and chemotherapy.
For patients with early or localized prostate cancer, active
surveillance, surgery or radiotherapy is the treatment of choice,
depending on risk of recurrence and expected survival.
• Surgery – Procedures can include the removal of all of the prostate
gland or part of it. Cryotherapy is minimally invasive and uses controlled
freeze and thaw cycles to destroy cancer cells.
Tests • Treatments
• Active surveillance (also called “watchful waiting”) – Prostate
cancer can progress slowly in some cases, and the risks or possible side
effects of the treatment options may outweigh the benefits. Hence, the
physician may recommend close monitoring of the health of the patient
rather than initiate treatment. If the cancer progresses or symptoms
occur, then the above treatment options may be considered.
• Radiation therapy – Radiation therapy can be delivered externally,
using high-energy rays from a machine directed at the target area of
the body to kill cancer cells, or internally, from small seeds implanted
inside the prostate tissue. The latter facilitates the use of a higher
total dose of radiation to treat a smaller area over a shorter duration
of time than is possible with external beam radiation therapy.
• Hormone therapy – Hormone therapy either inhibits the action
or blocks the production of male sex hormones that can stimulate
the growth of cancer cells. Hormonal control can be achieved
by surgical castration or by medical castration, using hormonal
drug therapy.
Luteinizing hormone-releasing hormone (LHRH) agonists prevent
the testicles from producing testosterone, thereby causing chemical
castration. An LHRH agonist may be combined with an antiandrogen
in order to further block the androgen receptor.
• Chemotherapy – Chemotherapy is a general term for treatments
that use chemical agents (drugs) to kill cancer cells. Many different
kinds of drugs are used, either alone or in combination to treat
different cancers, depending on the type and extent of the cancer.
• Immunotherapy – Immunotherapy is a form of biologic therapy or
biotherapy. The treatment uses certain parts of the immune system.
This is accomplished by either stimulating your own immune system
to work harder or smarter, or by giving your immune system
components, such as man-made immune system proteins.
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adenocarcinoma
(ad -n -kahr si-n m )
A malignant neoplasm of epithelial cells with a glandular or glandlike
pattern; prostatic adenocarcinoma is the most commonly
diagnosed cancer in men.
anaplasia
(an -pl z - )
Loss of structural differentiation, especially as seen in most, but
not all, malignant neoplasms.
anus
( n s)
The lower opening of the alimentary (digestive) tract, lying in the
cleft between the buttocks, through which feces or excrement
is discharged.
apoptosis
(a p´op-t ´sis)
Programmed cell death; deletion of individual cells by fragmentation
into membrane-bound particles, which are phagocytized
(ie, consumed) by other cells.
aspiration
(as´pir- ´sh n)
Removal, by suction, of a gas, fluid, or tissue from a body cavity or container.
It also means inhalation into the airways of a fluid or foreign body.
aspirator
(as pir- -t r)
An apparatus for removing fluid, air, or tissue by aspiration from any
of the body cavities; it usually consists of a hollow needle or trocar
and cannula, connected by tubing with a container vacuumized by
a syringe or reversed air (suction) pump.
bacterium
(bak-t r - m)
A unicellular microorganism that usually multiplies by cell division
and has a cell wall that maintains form; may be aerobic or anaerobic,
motile or nonmotile, and free-living, saprophytic, parasitic,
or pathogenic.
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biomarker
(b -mahr-k r)
A detectable cellular or molecular indicator of exposure, health
effects, or susceptibility, which can be used to measure the
absorbed, metabolized, or biologically effective dose of a substance,
the response to the substance including susceptibility and resistance,
idiosyncratic reactions, and other factors or conditions.
bladder
(blad r)
A stretchable musculomembranous organ that holds fluid (gallbladder,
urinary bladder).
calculus
(kal ky -l s)
A concretion formed in any part of the body, most commonly in the
passages of the biliary and urinary tracts; usually composed of salts of
inorganic or organic acids, or of other material (eg, cholesterol).
carcinoma of the prostate
(kahr si-n m pros t t)
At the time of diagnosis, more than 40% of patients have disease that
has spread beyond the gland. Bones of the axial skeleton are the usual
sites of distant metastasis. The liver, lungs, and brain are other common
sites. Early disease is asymptomatic; the diagnosis is most often made
by screening of apparently healthy men with digital rectal examination,
assay of prostate-specific antigen (PSA), or both. PA is graded by the
Gleason scoring method, which reflects the degree of histologic
differentiation in the two most prominent malignant foci.
Terms A–C
Prostatic adenocarcinoma (PA) is the most commonly occurring
visceral cancer in men, and it ranks second only to lung cancer as
a cause of cancer deaths in men. It is both more common and more
aggressive in African-American men. PA must be differentiated
diagnostically from benign prostatic hyperplasia, which is not a
premalignant lesion.
In elderly men and those with concurrent life-threatening illness,
benign neglect may be the treatment of choice. Radical prostatectomy
(removal of the entire gland along with the seminal vesicles) is
generally reserved for patients with early or limited disease and a life
expectancy of at least 10 years. This treatment is associated with
a substantial risk of urinary incontinence and impotence. Some
authorities oppose digital rectal examination and PSA screening of
asymptomatic men with life expectancies of less than 10 years, on
the grounds that the risks of false-negative results and of adverse
consequences of aggressive treatment outweigh any possible
benefit in survival or quality of life.
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catheter
(kath -t r)
A flexible tube that enables passage of fluid from or into a body cavity
or blood vessel (eg, one used to remove urine).
chemotherapy
(k m -th r -p )
Treatment of disease by means of chemical substances or drugs;
usually used in reference to cancer.
Chlamydia
(kl -mid - )
A bacterial genus that may be involved in prostate infections.
Formerly called Bedsonia.
complexed prostate-specific
antigen (PSA) test
(kom´plekst pros´t t sp -sif´ik an´ti-j n test)
Laboratory serum test to detect PSA complexed to
a1-antichymotrypsin; cPSA appears to be more specific for
detection of prostate cancer at low total levels of PSA than
measurement of total PSA and free:total PSA ratios.
cryptorchidism
(kript- r ki-dizm)
Failure of one or both testes to descend.
crystalluria
(kris-t l-y r - )
The excretion of crystalline materials in the urine.
cystectomy
(sis-tek t -m )
Excision of the urinary bladder, gallbladder, or any type of cyst.
cystoprostatectomy
(sis t -pros t -tek t -m )
Simultaneous surgical removal of bladder, prostate, and
seminal vesicles.
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cystoscopy
(sis-tos k -p )
The inspection of the interior of the bladder by means of
a cystoscope.
dehydroepiandrosterone (DHEA)
(d -h dr -ep- -an-dros t r- n)
A steroid secreted chiefly by the cortex of the suprarenal glands,
but also by the testes.
diarrhea
(d -r )
An abnormally frequent discharge of semisolid or fluid fecal
matter from the bowel.
digital rectal examination (DRE)
(dij´i-t l rek´t l eg-zam´i-n ´sh n)
Manual inspection using the physician's gloved finger to check
anatomic structures in the pelvis and lower abdomen.
empyema
(em p - m )
Terms C–E
Pus in a body cavity.
enuresis
(en-y r- sis)
Urinary incontinence (eg, bed-wetting).
erectile dysfunction
( -rek t l dis-f ngk sh n)
Inability to achieve or maintain an erect penis sufficient for sexual
intromission or for achieving orgasm.
erectile tissue
( -rek t l tish )
Body tissue with numerous vascular spaces that may become
engorged with blood.
erection
( -rek sh n)
The condition of erectile tissue when filled with blood, which then
becomes hard and unyielding; denoting especially this state of
the penis.
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Escherichia coli
(esh- -rik - k l )
Bacterial species that occurs normally in the intestines of humans
and other vertebrates, is widely distributed in nature, and is a
frequent cause of infections of the urogenital tract and prostate.
exstrophy
(eks tr -f )
Congenital outward turning of a hollow organ.
fecal incontinence
(f ´k l in-kon´ti-n ns)
Involuntary passage of feces onto clothing or bedclothes.
fungus
(f ng´g s)
A general term used to encompass the diverse morphologic forms
of yeasts and molds. Often involved in prostate disease.
glucuronide
(gl -ky r -n d)
A glycoside of glucuronic acid; agent produced by the body to
rid itself of toxic substances (eg, alcohol, drugs).
gonad
(g -nad)
An organ that produces sex cells; a testis or an ovary.
gonadoblastoma
(g -nad -blas-t ma)
Benign neoplasm composed of germ cells, sex cord derivatives,
and stromal cells but may give rise to malignant germ-cell tumors.
hypergonadism
(h p r-g nad-izm)
A clinical state resulting from enhanced secretion of gonadal hormones.
impotence
(im p -t ns)
Inability of the male to achieve or maintain penile erection and thus
engage in copulation; a manifestation of neurologic, vascular, or
psychological dysfunction. Often occurs after prostate surgery.
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Klebsiella
(kleb-s -el )
A genus of bacteria associated with prostate disease. These
organisms (which may or may not be pathogenic) occur in the
respiratory, intestinal, and urogenital tracts of humans as well as
in soil, water, and grain.
leuprolide acetate
(l pr -l d as -t t)
A synthetic nonapeptide analogue of naturally occurring
gonadotropin-releasing hormone; used in the palliative treatment
of advanced prostatic cancer.
libido
(li-b d )
Conscious or unconscious sexual desire.
neobladder
(n -blad r)
Surgically constricted (usually using tissue from the stomach
or intestine) replacement for a urinary bladder.
Terms E–N
nocturnal enuresis
(nok-t r n l en-y r- sis)
Urinary incontinence during sleep.
nodular hyperplasia of prostate
(nod´y -l r h ´p r-pl ´zh pros´t t)
Glandular and stromal hyperplasia, which is very common in the
transition zone and anterior fibromuscular stroma of older men,
forming nodules that may increasingly obstruct the urethra.
nomogram
(n ´m -gram)
A line chart in toxicology that relates time since toxic ingestion
with blood levels of the offending agent to estimate levels of toxicity
and to guide therapy.
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ostomy
(os t -m )
1. An artificial stoma or opening into the urinary or gastrointestinal
canal, or the trachea.
2. Any operation by which a permanent opening is created
between two hollow organs or between a hollow viscus and
the skin externally, as in tracheostomy.
papaverine
(p -pav r- n)
A nonnarcotic benzylisoquinoline alkaloid of opium that has mild
analgesic action and is a powerful spasmolytic; has been used to treat
male impotence by local injection.
podophyllotoxin
(pod -fil -tok sin)
A toxic polycyclic substance with cathartic properties present in
podophyllum; active against some cancers.
prostatalgia
(pros t -tal j - )
Any pain in the area of the prostate gland.
prostate
(pros t t)
A chestnut-shaped body, surrounding the beginning of the urethra in
the male, which consists of two lateral lobes connected anteriorly by an
isthmus and posteriorly by a middle lobe lying above and between
the ejaculatory ducts. The secretion of the glands is a milky fluid that
is discharged by excretory ducts into the prostatic urethra at the time
of the emission of semen. Usage note: Often mispronounced as
prostrate, and so misspelled.
prostate-specific antigen (PSA)
(pros t t-sp -sif ik an ti-jen)
A single-chain, 31-kD glycoprotein with 240 amino acid residues and
4 carbohydrate side-chains; a kallikrein protease produced by
prostatic epithelial cells and normally found in seminal fluid and
circulating blood. Elevations of serum PSA are highly organ-specific
but occur in both cancer (e.g., adenocarcinoma) and benign
disease (e.g., benign prostatic hyperplasia, prostatitis). A significant
number of patients with organ-confined cancer have normal
PSA values.
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prostatectomy
(pros t -tek t -m )
Removal of part or all of the prostate.
prostatic
(pros-tat ik)
Relating to the prostate.
prostatic calculus
(pros-tat ik kal ky -l s)
A concretion (ie, stone) formed in the prostate gland, composed
chiefly of calcium carbonate and phosphate.
prostatic fluid
(pros-tat ik fl id)
Also called succus prostaticus. A whitish secretion that is one of the
constituents of semen.
prostatic intraepithelial neoplasia (PIN)
(pros-tat ik in-tra-ep i-th l - l n -pl z - )
Abnormal changes involving glands and ducts of the prostate that
may be a precursor of adenocarcinoma.
Terms O–P
prostatic massage
(pros-tat ik m -sahzh )
1. Manual rectal expression of prostatic secretions by digital
rectal technique.
2. Emptying of prostatic acini and ducts by repeated downward
compression maneuvers, for treatment of various congestive
and inflammatory prostatic conditions.
prostatic sinus
(pros-tat ik s n s)
The groove on either side of the urethral crest in the prostatic
part of the urethra into which the prostatic ducts open.
prostatic utricle
(pros-tat ik y tri-k l)
A very small pouch in the prostate that opens on the summit of
the seminal colliculus.
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prostatism
(pros t -tizm)
A clinical syndrome, occurring mostly in older men, usually caused
by enlargement of the prostate gland and manifested by irritative
symptoms (waking at night to urinate, frequency, sensory urgency,
and urgent incontinence) and obstructive symptoms (hesitancy,
decreased stream, terminal dribbling, double voiding,
and urinary retention).
prostatitis
(pros t -t tis)
Inflammation of the prostate. The National Institutes of Health
consensus designates four categories of prostatitis: I, acute
bacterial prostatitis; II, chronic bacterial prostatitis; III, chronic
prostatitis/chronic pelvic pain syndrome: A, inflammatory and B,
noninflammatory; and IV, asymptomatic inflammatory prostatitis.
prostatocystitis
(pros t -t -sis-t tis)
Inflammation of the prostate and the bladder; cystitis by extension
of inflammation from the prostatic urethra.
prostatodynia
(pros t -t -din - )
Another name for prostatalgia.
prostatorrhea
(pros t -t -r )
An abnormal discharge of prostatic fluid.
prostatovesiculitis
(pros t -t -v -sik y - l tis)
Inflammation of the prostate gland and seminal vesicles.
Proteus
(pr t - s)
A bacterial genus involved in prostatic infections.
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radioactive seed implants
(r ´d - -ak´tiv s d im´plants)
Newer form of radiation therapy for prostate cancer in which
radioactive seeds are permanently placed in a cancerous prostate;
method allows for therapy that minimizes damage to other tissue.
retrograde ejaculation
(ret r -gr d -jak y -l sh n)
Delivery of semen ejaculate into the bladder; seen in neurologic
disease, diabetes, and occasionally after prostate surgery.
scrotum
(skr t m)
A musculocutaneous sac containing the testes; formed of skin,
containing a network of muscular fibers, which also form the
scrotal septum internally.
semen
(s m n)
The penile ejaculate; a thick, yellowish-white, viscid fluid containing
sperm; a mixture produced by secretions of the testes, seminal
glands, prostate, and bulbourethral glands.
The male gamete or sex cell that contains the genetic information to
be transmitted by the male. The human sperm is composed of a head
and a tail, the tail being divisible into a neck, a middle piece, a principal
piece, and an end piece; the head, 4–6 mcm in length, is a broadly
oval, flattened body containing the nucleus; the tail is about 55 mcm
in length.
Terms P–T
sperm
(sp rm)
stoma
(st ´m )
An artificial opening between two cavities or canals, or between
such and the surface of the body. Frequently used to place an
ostomy bag for incontinence.
testis
(tes tis)
One of the two oval male gonads (reproductive glands), located
in the cavity of the scrotum. The seminiferous tubules of the testis
are the site of spermatogenesis and its Leydig cells secrete
testosterone as well as estrogens and other androgenic
steroid hormones.
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transurethral resection of prostate (TURP)
(tranz´y r- ´thr l r -sek´sh n pros´t t)
Endoscopic removal of the prostate gland or bladder lesions, usually
for relief of prostatic obstruction or treatment of malignancies.
ultrasonography
( l tr -s -nog r -f )
The location, measurement, or delineation of deep structures
by measuring the reflection or transmission of high-frequency
or ultrasonic waves. Computer calculation of the distance to the
sound-reflecting or absorbing surface plus the known orientation
of the sound beam gives a two-dimensional image.
ureterostomy
(y r- t r-os t -m )
Establishment of an external opening into the ureter.
urethra
(y r- thr )
A canal leading from the bladder, discharging the urine externally.
urethroplasty
(y r- thr -plas t )
Surgical reconstruction of the urethra.
urinary bladder
(y r i-nar- blad r)
A musculomembranous elastic bag serving as a storage place
for the urine.
urinary incontinence
(y r´i-n r- in-kon´ti-n ns)
Involuntary voiding of urine into clothing or bedclothes. A common
problem in older people, especially those in long-term care facilities,
which may be due to neurologic abnormalities, loss of sphincter
function (especially common in women who have had several
children), chronic bladder outlet obstruction, or loss of
cognitive functions.
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Terms T–U
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©2011
Published by Anatomical Chart Company, IL, USA
pharma.wkhealth.com
©2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
© Janssen Biotech, Inc., Division of Janssen Products, LP 2011 11/11 08ADA10041R1
Janssen Biotech, Inc.
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