Prostate and urethra

prostate

1. Prostate & Urethra

2. Prostate
•Fibromuscularorgan
•Accessory sex gland
•Corresponds (homologus) to
Paraurethralgland of Skene

3. Prostate -Situation
•Within
–True Pelvis
•Behind the
–Pubic symphysis
•In front of
–Rectal ampulla
•Below the
–Urinary bladder
•On either side of it
–Levatorani

4. Dimensions
•Breadth –4 cm
•Length –3 cm
•Anteroposterior-2 cm
•Weight –8 gm
The other organ which is more wider
than length is Caecum

5. Parts
•Has 3 parts
–Base
–Apex
–Body
•Has 4 surfaces
–Anterior
–Posterior
–Inferolateral
•Has 5 lobes
–Anterior
–Posterior
–Median
–2 lateral

6. Base
•Directed upwards
•Surrounds
–Neck of Urinary bladder
•Pierced by
–Urethra
•At the junction of
–Ant 1/3
rd
and post 2/3
rd

7. Apex
•Facing downwards
•Rests on
–Urogenital diaphragm

8. Surfaces
•Anterior
–2 cm behind the pubic
symphysis
–Separated from symphysis by
•Retropubicspace of Retzius
–Pierced by urethra
•Just above the apex

9. Surfaces
•Posterior
–Lies infrontof Rectal
ampulla
–Denonvilliersfascia
separates
•From ampulla
–Transverse sulcus divides
this surface into
•Meidanlobe
–Upper smaller
•Lower larger area
–Divided by a median
sulcus
»2 lateral lobes

10. Surfaces
•Inferolateral
–Related to Levatorani
muscle

11. Capsules
•Two
–Outer False / prostatic
sheath
•Visceral layer of pelvic
fascia
–Inner true
•Fibromuscular
–Prostatic venous plexus
•Lies between 2 capsules

12. False capsule
•Visceral layer of pelvic
fascia
•Continuous
–Above with neck of bladder
–Below with superior layer of
urogenitaldiaphragm
–Infrontwith puboprostatic
ligament
–Behind with fascia covering
seminal vesicle & Vas

13. Inner true capsule
•Fibro muscular capsule
•Condensation of peripheral
fibrous stroma
•Divides the gland into
glandular lobes

14. Interior
•2 structures traverse
–Urethra
–2 ejaculatory ducts

15. Prostatic urethra
•Extent
–From
•Internal urethral orifice (base)
–To
•Superior layer of urogenital
diaphragm(emerges out in
front of apex)

16. Prostatic urethra
•Presenting parts
•Urethral crest
–Longitudinal elevation
•On post wall
•Colliculusseminalis
–A dilatation on upper part of the
crest
–Openings in colliculus
•3
–In centre
»Prostatic utricle
–Two lateral
»Ejaculatory ducts
•Prostatic sinuses
–2 depressions on each side of
urethral crest

17. Lobes
•Anterior
–Lies in front of urethra
–Connecting lateral lobes
–Devoid of glands
•Median
–Lies
•Behind upper urethra
•In front of ejaculatory ducts
•Projects into urethra as a ridge
–Urethral crest
•Base produces an elevation
–At apex of Trigone
»Uvula vesicae
•Has glandular tissue
–Common site of adenoma

18. Lobes
•Posterior
–Lies behind ejaculatory duct &
median lobe
–Primary carcinoma starts here
•Lateral
–Lies on either side of urethra
–Has some glandular tissue
•Adenoma starts here at old age

19. Structure
•Divided into 3 zones
–By fibrous layer
•Innermost zone/ inner periurethral
–Has mucosal glands
•Inner / outer periurethral
–Has submucosal glands
•Outer / peripheral zone
–Composed of prostatic gland proper

20. Supports
•Urogenital diaphragm
•Puboprostaticligaments
–Medial (pair)
–Lateral (pair)
•Fascia of Denovillers

21. Age changes
•At birth
–Small size
–Made of -Stroma& duct
•At puberty
–Double the size
–Growth of follicle & condensation
of stroma
•At 20-30 years
–Follicles are irregular
•Due to irregular epithelial growth
•At 40-45
–Small In size
–Due to senile atrophy

22. Lower urinary tract symptoms
•Cause
–Benign prostatic urethraleads
to
•Bladder outlet obstruction
•Signs
–Decreased force of stream
–Increased frequency
–Urgency
–Difficult in starting &
stopping of urination
–Sense of incomplete emptying

23. URETHRA
வடிகுழாய்

24. Male urethra
•18 –20 cm long
•Common duct for both
–Urinary and genital systems
•Passage of
–Both urineand semen
•Extends
–Internal urethral orifice
•Neck of bladder
•To
–External urethral orifice
•Tip of penis

25. Features
•Flaccid condition
–S Shaped
–Has 2 cuvatures
•Proximal & distal
•Erect condition
–J shaped
–Has 1 curvature
–Distal curvature disappears Proximal
Distal

26. Preprostatic
Spongy
urethra
•Pre prostatic part –1 cm
•Prostatic part –3 cm
•Membranous part –1 cm
•Spongy part –15 cm

28. •Urogenital diaphragm
–Superior fascia
–Inferior fascia
–Muscles
•Sphincter urethra
•Deep transverse perinei

29. Preprostaticpart
•About 1 cm long.
•Extends from the base of the
bladder to the prostate
•associated with a circular cuff
of smooth muscle fibers (the
internal urethral sphincter).
•Contraction of this sphincter
prevents retrograde movement
of semen into the bladder
during ejaculation.

31. Prostatic part
•3 cm in length
•Lies within prostate
•Widest and dilatable part
•Widest in the middle
–8 cm
•From
–Internal urethral orifice
–base of prostate
•To apex of prostate
•Lies at the junction of
–Anterior 1/3
rd
and posterior
2/3
rd
of gland

32. Posterior wall of Prostatic urethra
Prostatic utricle –homologusto vagina and uterus
Embryology –fused ends of Mullerian/ Paramesonephric ducts
•Urethral crest
–Longitudinal ridge of
mucosal fold in the middle
•Urethral crest
•Colliculus seminalis
–Elevation on middle of
urethral crest
–Has 3 openings
»Prostatic utricle
»Ejaculatory ducts on
sides
•Prostatic sinus
–Vertical grooves on sides of
urethral crest
–Has openings of prostatic
gland (15-20)

33. Membranous part
•Lies in deep perineal pouch
•Narrowest part
–2
nd
narrowest after external urethral metus
–Least dilatable part
•Surrounded by
–Sphincter urethrae
•On each side
–Bulbourethral gland
•Pierces urogenital diaphragm
•From superior fascia of urogenital
diaphragm
•To inferior fascia of urogenital diaphragm
•Lies 2.5 cm behind lower border of pubis
•Anterior wall is 2 cm
•Posterior wall is 1.25 cm

34. Membranous part -Relations
•Infront
–Deep dorsal vein of
penis (lies between
transverse perineal ligament
and arcuate pubic ligament)

35. Parts of Penis

36. Spongy part
•Passes through
–Bulb
–Corpus spongiosum
•15 cm in length
•Shows
–2 dilatations
•External urethral meatus
–Most narrowest part

37. Spongy part -features
•2 dilatations
–Intra bulbar fossa
•On floor (more dilatation)
–Navicular fossa
•On roof (more dilatation)
•Urethral glands / Littres
gland
–Mucous glands
–Except terminal fossa
•Urethral lacuna
–Inbetweenmucosa
–Lacuna magna
•Navicular fossa’s roof

38. Lumen of urethra
•Transverse section in
different levels
–Prostatic urethra
•Crescent shape
–Membranous urethra
•Stellate shape
–Bulbar fossa
•Trapezoid
–Body of penis
•Transverse slit
–Base of glans
•Inverted T
–External urethral meatus
•Vertical slit

39. Sphincters urethra
•Internal sphincter /
sphincter vesicae
–Smooth muscle
–At neck of bladder
–Involuntary
•External sphincter
–Skeletal muscle
–Voluntary

40. Male urethra -Epithelium
•Up to opening of ejaculatory
ducts -transitional
epithelium
•Near external urethral orifice
-stratified squamous
epithelium
•In between -stratified
columnar epithelium

41. Arterial supply
•Branches of
–Inferior vesical
–Middle rectal
–Internal pudendal
–Artery to bulbof penis

42. Anomalies
•Hypospadias
–Urethra opens the
undersurface of penis
•Epispadias
–Urethra opens on dorsal
surface

43. Female urethra
•4 cm long
•Begins
–Internal urethral orifice
•Ends
–Urethra pierces perineal
membrane
–Opens in vestibule

44. Female Urethra
•3 to 4 cm long
•Internal urethral sphincter
–detrusor muscle thickened,
smooth muscle, involuntary
control
•External urethral sphincter
–skeletal muscle, voluntary
control
–between vaginal orifice and
clitoris
–External urethral orifice

45. The female urethra
The urethra
extends from the
neck of the
bladder to the
vulva.
It is exclusively
urinary

46. Glands around female urethra
•Urethral glands
–Surround entire urethra
•Para urethral glands
–Corresponds to prostate
gland of male
•Greater vestibular glands
–Situated behind bulb of
vestibule

47. Catheterization

48. Congenital anomaly -Hypospadiasis
•Failure of the fusionof
Urethral or urogenital
folds ventrallylead to
hypospadias (urethra
opening ventrally)

49. Congenital anomaly -Hypospadiasis
•Due to failure of fusion of
urethral folds
•Urethra opens on the ventral
surfaceat different levels