prostateAnatomyand lobeswith agechanges.pptx

Anatomy of Prostate for UG student of MBBS

1. Prostate gland

2. Prostate gland Accessory gland of male reproductive system located in pelvic cavity Composed of fibromuscular stroma and embedded with glandular tissue. Size and activity is under the influence of testosterone Secretions add to the seminal fluid Secretions rich in acid phosphatase In female prostate is represented by paraurethral gland of skene

3. Paraurethral glands Paraurethral glands (or Skene glands)  lie within the wall of the distal female urethra and secrete mucus . Each gland is drained by a single paraurethral ( Skene ) duct. They are homologous to the male prostate gland.

4. Bladder Prostate Rectum Pubic symphysis Urethra Prostate gland - location Lies: behind the pubic symphysis In front of rectal ampulla Below the urinary bladder surrounding the neck

5. Prostate Ejaculatory duct Vas deference Seminal vesicle Apex Base Posterior surface Prostate gland Shape: inverted cone Base – upwards Apex – downwards Vertical – 3cm Base – 4cm Anteroposterior – 2cm Weight – 7-16gm Urethra passes through it

6. Prostate Apex Posterior surface Prostate gland Inferolateral surface Base It has four surfaces : Base (superior) Anterior Posterior Two inferolateral Apex

7. Prostate gland-relations Levator ani Urogenital diaphragm Base Apex Inferolateral surface Prostatic plexus Base – neck of bladder. Urethra pierces in median plane at the junction of ant. 1/3 and post 2/3. junction of prostate and bladder marked by circular groove.

8. Prostate gland- relations Apex: is rest on the superior surface of urogenital diaphragm apex Urogenital diaphragm

9. Prostate - relations Posterior: Rectal ampulla Rectovesical fascia Pubic symphysis Retropubic space Prosatatic venous plexus Anterior Urethra pierces the anterior surface slightly above the apex

10. Prostate – posterior surface It is pierced by the ejaculatory ducts which divide this surface in to a smaller upper and a lower larger part. Upper part belongs to the median lobe Ejaculatory duct Ampulla of rectum is seprated by the fascia of Denonvilliers

11. Inferolateral surfaces: Related to the anterior fibers of levator ani muscle Relations of prostate gland Levator ani

12. True and false capsules Between the two there is prostatic venous. It is absent posteriorly True capsule – peripheral condensation of connective tissue stroma Prostate gland - capsule

13. Capsules and ligaments of Prostate True Capsule It is formed by condensation of the peripheral part of the gland. It is fibromuscular in structure and is continuous with stroma of the gland. The lies between true and false capsules venous plexus .

14. False Capsule It lies outside the true capsule and is derived from the endopelvic fascia . Anteriorly , it is continuous with the puboprostatic ligaments. On each side, the prostatic venous plexus is embedded in between false and true capsules. Posterioily , it is avascular , and is formed by the rectovesical fascia of Denonvilliers . A pair of medial puboprostatic and a pair of lateral puboprostatic ligaments extend from the false capsule to the back of pubic bone. The medial pair lie near the apex while lateral pair is close to the base. These four Iigaments support the gland.

15. Prostate gland - capsule False capsule – part of pelvic fascia Puboprostatic ligaments are attached to it Puboprostatic ligaments – medial and lateral connect prostate to pubic symphysis and pubic bone Form the floor of retropubic space

16. Prostate gland - lobes Anterior Lateral Posterior Urethra Ejaculatory duct Median Prostatic utricle

17. Prostate gland - lobes Divided incompletely in to 5 lobes Anterior lobe or isthmus – lies in front of urethra connects the lateral lobes . It is made up off fibromuscular tissue. No glandular tissue Posterior lobe: lies behind the urethra and connects the posterior ends of the lateral lobes. It contains glandular tissue and site of primary carcinoma

18. Lies behind urethra, above the ejaculatory ducts. It produces a bulge called uvula vesicae at the lower part of the trigone of bladder. It contains more number of glandular tissue and is prone for benign hypertrophy of the prostate. Median/middle lobe:

19. Prostate gland - lobes Lateral lobes: lie on either side of the urethra It contains numerous glands May give rise to adenoma

20. Prostate can be divided into 3 zones Inner- mucosal Middle – submucosal Outer – contain main glands. The ducts of which open in the prostatic sinus Prostate gland

21. Prostate gland – blood supply Arterial supply: inferior vesical, middle rectal and internal pudendal arteries Venous drainage: prostatic venous plexus which lies between the true and false capsules It receives deep dorsal vein of penis

22. Prostate gland – blood supply Prostatic venous plexus drains in to vesical venous plexus This drains in to internal iliac veins These plexus of veins are connected to internal vertebral plexus of veins ( do not have valves) These connections form important route for depositing malignant cells from prostate to the vertebral bodies and skull

23. Lymphatic drainage of prostate External iliac group Preaortic group Presacral group Internal iliac group

24. Age changes in prostate gland Newborn and child: fibromuscular stroma and rudiments of the duct system Puberty: sudden in growth under the influence testosterone follicles develop and proliferate and begin secreting acid phosphatase , prostate specific antigen and prostaglandins

25. Age changes in prostate gland From 20 to 30 years : epithelium grows by multiplications with infoldings in the lumen of the follicles, making them irregular. After 31 - 45 : epithelium infoldings disappears and amyloid concretions start forming inside the follicles . years may show benign hypertrophy or progressively atrophy.

26. THANK YOU

27. SEMINAL VESICLES The seminal vesicles are two coiled sacculated tubes about 2 inches (5 cm) long which can be unraveled to three times of this length. They lie extraperitoneally on each side, at the base of the urinary bladder, lateral to the termination of the vas deferens and in front of the rectum. The lower narrow end of seminal vesicle (duct of seminal vesicle) joins the ductus deferens to form the ejaculatory duct. It do not form a reservoir for sperms. Their secretions form a large amount of the seminal fluid. The secretion of seminal vesicles is slightly alkaline, containing fructose, choline , and a coagulating enzyme called vesiculos .

28. The secretion of seminal vesicle contains fructose, which is not produced anywhere else in the body. This provides a forensic evidence of the occurrence of rape. However, choline crystals provide the preferred basis for determination of the presence of seminal fluid (Florence test).

29. Applied aspects It is easily palpable per rectum Median lobe undergoes benign hypertrophy Carcinoma most common malignant tumor in males over 65 years of age Surgical removal: retropubic approach Suprapubic transvesical approach Transurethral approach – most accepted. It is known as transurethral resection of prostate (TURP)

30. Symptoms of Prostate Cancer? Difficulty starting urination. Weak or interrupted flow of urine. Frequent urination, especially at night. Difficulty emptying the bladder completely. Pain or burning during urination. Blood in the urine or semen. Pain in the back, hips, or pelvis that doesn’t go away. Painful ejaculation.

31. Rectal examination of Prostate It is easily palpable per rectum. The discussion about screening should take place at:  Age 50  for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer.

32. Fibromuscular tube. 18 – 20 cm length Common passage for urine and semen Begins at the neck of bladder passes through prostate, pelvic diaphragm, perineal pouches and penis Opens at the external urethral orifice at the tip of glans It shows double curve when penis is flaccid state Male urethra urethra

33. Prostatic membranous Spongy External urethral meatus Preprostatic Male urethra – parts

34. Preprostatic part Extends from the neck of the bladder to the base of prostate Length :1cm Surrounded by smooth muscle which is part of sphincter vesicae. Richly innervated by sympathetic fibers Prevents retrograde ejaculation of semen Preprostatic part

35. Length: 2.5cm Most dilatable part of the urethra Lumen crescentic in shape Begins at the base of the prostate Emerges out on the anterior surface of the prostate Has a median crest in the posterior wall called urethral crest Prostatic urethra

36. Colliculus seminalis Urethral crest Prostatic utricle Ejaculatory duct Prostatic ducts Prostatic urethra -features The depression on either side of the crest is the prostatic sinus It receives the openings of the ducts of the gland

37. Median crest shows a rounded swelling called colliculus seminalis It has the openings of the prostatic utricle opening of ejaculatory ducts Prostatic urethra - features

38. Membranous urethra Length : 1.5cm Lies in the deep perineal pouch Narrowest and least dilatable part Cross section – stellate shaped Bulbourethral glands lie on either side Surrounded by sphincter urethrae Memembranous urethra Bulbourethral galnd Sphincter urethrae

39. Length : 15cm Passes through the bulb in the superficial perineal pouch, corpus spongiosum and glans penis Part in the bulb is dilated to form intrabulbar fossa Spongy or penile part of the urethra

40. In this part it receives the opening of bulbourethral gland In the bulbar fossa the anterior wall is shorter than the floor and sides Cross section – trapezoid shape Bulbar fossa Bulbourethral gland Spongy or penile part of the urethra

41. It passes through the corpus spongiosum of the penis Transverse section – transverse slit Part in the glans is called – navicular fossa or terminal fossa which is a vertical slit It opens at the tip as external urethral opening or meatus Navicular fossa Bulbar fossa Spongy or penile part of the urethra

42. Urethral glands (glands of Litter) open in the entire spongy urethra in mucous out pouching called lacunae Largest lacuna is present in the roof of the navicular fossa (lacuna magna) Spongy or penile part of the urethra

43. Female urethra 4cm long Related to the anterior wall of vagina Paraurethral glands open here It is equivalent to the prostatic urtethra upto the colliculus seminalis

44. 57 Posterior Bladder

45. Bulbourethral Glands (Cowper's) small, about the size of a pea, and located near the base of the penis. A short duct from each enters the proximal end of the penile urethra. In response to sexual stimulation, the bulbourethral glands secrete an alkaline mucus-like fluid

46. 59 Bulbourethral Glands (Cowper’s Glands) Pea-sized glands inferior to the prostate Produce alkaline mucus prior to ejaculation that neutralizes traces of acidic urine in the urethra