Download MBBS Prostate Lecture PPT

PROSTATE GLAND
INRODUCTION

The Prostate is a conical Fibro-Musculo-Glandular organ surrounding

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the proximal part of male urethra.

? Corresponds with paraurethral glands of female developmentally.

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? Secretion of Prostate forms considerable part of semen.

? Is slightly acidic, contains acid phosphatase, fibrinolysin,

prostaglandin and large amount of Zinc.

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? Situation:

Lesser pelvis below the neck of bladder, above urogenital

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diaphragm, behind the lower part of symphysis pubis,

anterior to rectal ampulla and on each side embraced by

levator ani muscle.

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? Measurements:

? Chest nut in appearance.

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? Transverse (at base): 4 cm.

? Vertical: 3 cm

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? Anteroposterior: 2 cm.

? Weight : 8 gm.
Presenting Parts of Prostate gland

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-Apex: Directed downwards, in contact with Superior fascia of

urogenital diaphragm.

- Base : Directed upwards, surrounding the neck of the bladder,

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pierced by urethra in median plane at the junction of ant. 1/3rd and

post. 2/3rd of the gland.

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Presenting Parts of Prostate gland

? Anterior surface : narrow

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and convex and situated

about 2cm behind lower part

of symphysis pubis

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separated by retropubic fat,

prostatic venous plexus and

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deep dorsal vein of penis.

? Posterior surface: broad,

flat, related to the ampulla of

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rectum separated by

rectovesical fascia.This

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surface is palpable by rectal

examination about 4 cm

above anus.

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Presenting Parts of Prostate gland

? Posteror surface is subdivided by transverse groove into

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upper small and lower large areas. It is pierced by

ejaculatory ducts on each side. The upper area forms

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median lobe; lower area is subdivided by a median sulcus

into two lateral lobes.

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Presenting Parts of Prostate gland

? Each of two Infero-lateral surfaces, related to the anterior

fibres of levator ani which acts as levator prostate; anterior

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recess of the ischio-rectal fossa lies outside the levator ani.


LOBES OF PROSTATE GLAND

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5 lobes: Median, Anterior, Posterior and two lateral.

left view of a sagittal section Coronal section through posterior half of gland;

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LOBES OF PROSTATE GLAND

The median lobe: is wedge shaped, apex directed below towards

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colliculus seminalis, base forms uvula vesicae at the apex of trigonum

vesicae.

Bounded anteriorly by urethra, behind and on each side by the

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ejaculatory duct, behind and in the median plane by prostatic utricle.

This lobe is predominantly fibro-muscular with mucus glands.

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LOBES OF PROSTATE GLAND

The two lateral lobes are separated superficially by posterior median

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sulcus , but deep to the sulcus and behind urethra both the lobes are

continuous.

This continuity is described as posterior lobe surgically.

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Each lateral lobe covers sides of urethra and in front of urethra are

connected by fibro-muscular isthmus,which is known as anterior lobe

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in foetal life containing glands.(may persist upto 6 years after birth)
FASCIAL RELATIONS

The prostate is related to the two capsules and one fascia behind

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1. True Capsule

Formed by the condensation of the peripheral fibrous stroma of the

gland

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2. False Capsule

Formed by the visceral layer by the pelvic fascias.

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(The prostatic venous plexus lies between these capsules)

Hence plane of enucleation of prostatic adenoma lies deep to both the

capsules.

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Surgical Capsule/pathological capsule

Formed by the non adenomatous tissue of the prostate which

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is pushed by the hypertrophied gland to the periphery

Fascia Behind the Prostate

it is also known as rectovesical, prostatoperitonial,denonvillier's fascia

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Structures traversing the Prostate gland

?

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Prostatic urethra: runs vertically

downwards from base to slightly in

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front of apex, at the junction of ant.

1/3rd and post. 2/3rd of gland.

?

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Pair of ejaculatory ducts: each

passes postero-lateral to median

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lobe, opens at the colliculus on each

side of prostatic utricle.

?

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Prostatic utricle: is mucus cul ?de-

sac, about 6mm long, extends

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upwards, and backwards from

colliculus behind the median lobe.
STRUCTURE OF PROSTATE GLAND

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Consist of 1/4th fibrous, 1/4th muscular and 2/4th glandular

tissue.

? Fibrous tissue: forms true capsule at the periphery,postero-

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median fibrous septum connects capsule with urethral crest.

?Muscular tissue: smooth muscle, continuous with detrusor

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muscle, arranged in outer and inner sheets, connected by

radiating fibres. Spaces between these fibres occupied by
?follicles of the gland.

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?There are transversely oriented arched striated muscle

fibres within the prostate anterior to the urethra, blending

with fibrous capsule postero-laterally and with postero-

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median septum.


Glands of prostate are arranged in 3 layers:

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? Inner mucous glands

? Intermediate submucous glands

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? Outer main glands
BLOOD SUPPLY

Arterial supply :

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1. Inferior vesical artery

2. Middle rectal artery

3. Internal pudendal arteries

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Venous drainage:

Veins form prostatic plexus in between true and false capsules. Plexus

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receives deep dorsal vein of penis anteriorly and communicates above

with the vesical venous plexus. Finally draining into internal iliac vein.

Few veins from prostate pass backwards through anterior sacral

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foramina , draining into internal vertebral venous plexus, known as

paravertebral veins of Batson. (metastatic spread of cancer prostate to

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vertebrae)
Lymphatic drainage:

1. Internal iliac group of lymph nodes.

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2. External iliac group of lymph nodes

3. Sacral group of lymph nodes.

Nerve supply:

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1. Superior Hypogastric plexus conveys sympathetic

nerves(L1,L2 preganglionic fibres)

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2. Parasympathetic fibres derived from pelvic splanchnic

nerves conveying preganglionic fibres from S2, S3, and

S4.(secretomotor to gland)

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AGE CHANGES IN PROSTATE GLAND

In newborn: consist basically of duct system in

fibromuscular stroma. Before puberty grows slowly and

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rudimentary follicles bud out from sides of ducts.

At Puberty: shows sudden growth, doubles in size. Follicles

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shows infoldings. Above 45 years age mucous folds

disappears and follicles contains corpora amylacea.

In old age: It may atrophy or show hypertrophy.

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APPLIED ANATOMY

? Prostatitis

? Benign hypertrophy of prostate.

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? Prostatectomy:

i) Suprapubic approach

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ii) Transurethral resection of prostate

(TURP)

?Carcinoma of Prostate.

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?Digital per rectal examination.
URETHRA

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Male urethra

The male urethra is

about 20.0 cm

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long and is divided

into three parts-

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? Prostatic,

? Membranous

? Spongy

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(penile).


The anterior urethra

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? It is about 16 cm long and

surrounded by the corpus

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spongiosum. It is subdivided

into:

? The bulbar urethra which is

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more proximal, surrounded by

the Bulbospongiosus muscles

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and lie entirely within the

perineum.

? The penile urethra which is

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distal and continues to the tip

of the penis.

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The posterior urethra

? It is about 4 cm long and lies in the

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pelvis

proximal to the corpus spongiosum.

The

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posterior urethra is divided into:

? The pre-prostatic part of the urethra.

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? The prostatic part is the widest and

passes through the prostate.

? The membranous (sphincteric) part is

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the shortest and narrowest part. In the

deep perineal pouch, it

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is surrounded by distal (external)

urethral sphincter.

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Parts of male urethra
Preprostatic urethra

? approximately 1 cm in length.

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? extends from the base of the bladder

to the prostate.

? Small periurethral glands at this site

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may contribute to benign prostatic

hyperplasia (BPH) and symptoms of

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outflow obstruction in older men.


Prostatic urethra

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? is 3?4 cm in length

? passes through the substance of

the prostate, closer to the anterior

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than the posterior surface of the

gland.

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? It is continuous above with the

preprostatic part and emerges

from the prostate slightly anterior

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to its apex.

? - Length: 3.0 cm

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Prostatic urethra

- Features:

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In its posterior prostatic urethra wall there

is urethral crest with a round swelling

colliculus seminalis in the middle.

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? There are three openings on

the colliculus seminalis:

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? One median for prostatic utricle.

? Two lateral for the ejaculatory ducts.

? On either side of urethral crest, there is a

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shallow depression-prostatic sinusfor

prostatic glands ducts opening.

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Membranous urethra

? lies in the deep perineal pouch.

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? This is the narrowest segment of male

urethra.

? It is having thickened circular muscles in

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its walls i.e. sphincter urethrae- that acts as

a voluntary external sphincter.

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? more susceptible to injury, during

passage of instrument through urethra due

to

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I. Its narrowest part with delicate walls.

II. Its angulation with the spongy urethra.

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III. Length: 2.0 cm


Spongy (penile) urethra

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? The longest part of male urethra.

? Length-I5 cm.

? It begins below the perineal membrane

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and ends at external urethral meatus.

? This part lies within the bulb of penis,

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corpus spongiosum and glans of penis.

? There are two dilatations in this part:

i. One intrabulbar fossa in the bulb of

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penis.

ii. One navicular fossa in the glans of

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penis.


Spongy (penile) urethra

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? The ducts of bulbo-urethral (Cowper's)

gland open in this part just below

urogenital diaphragm.

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? The dorsal wall of spongy urethra has

- Openings of many mucus glands.

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- Lacunae or pit-like recesses directed

forwards. The lacuna magna lies in the

navicular fossa.

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? The spongy urethra ends at external

urethral meatus, that is a sagittal slit,

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about 6 mm long at the tip of the glans.

? The external meatus is guarded by two

lateral labia. It is the narrowest point of

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male urethra. If an instrument can pass

through it, it can easily pass through rest

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of urethra.


URETHRAL MUCOSA

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1. Prostatic urethra above the

seminal colliculus is lined by

transitional epithelium and

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below it by stratified columnar

epithelium.

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2. Membranous urethra is lined

by stratified columnar

epithelium.

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3. Spongy urethra up to navicular

fossa is lined by stratified

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columnar epithelium. The

navicular fossa and external

urethral orifice are lined by

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stratified squamous epithelium.
ARTERIAL SUPPLY

? Urethral artery

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? just below the perineal membrane it arises from

? the internal pudendal artery

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? or common penile artery

? runs through the corpus spongiosum, to reach the glans penis.

? It supplies ? the urethra and ? erectile tissue around it.

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In addition, the urethra is supplied by

? the dorsal penile artery

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? via its circumflex branches on each side and

? retrogradely from the glans, by its terminal branches.

? The blood supply through the corpus spongiosum is so plentiful that

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the urethra can be divided without compromising its vascular

supply.

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APPLIED

1.Rupture of the urethra.
2. Catheteristion of

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urethra.

3.Hypospadias.

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Female urethra

? it is about 4.0 cm long and 6mm

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diameter.

? It extends from the neck of bladder to

the external urethral meatus.

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? the external orifice is situated in front

of the vaginal opening and about 2.5 cm

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behind the clitoris.

? It is homologous with upper part of

Prostatic urethra of males.

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? Location: The female urethra is

embedded in anterior wall of vagina.

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Thus in cases of difficult child-birth, it is

more likely to be lacerated.
Lumen of Urethra on cross section

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? At the internal orifice- crescentic

with the convexity directed in front

.

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? At the middle- transverse slit.

? At the external orifice- sagittal slit.
Glands around the female urethra

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? Urethral glands-

? These are tubular mucous glands

? surround the entire urethra.

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? Para-urethral glands-

? These correspond with the prostate gland of male

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? their ducts open close to the external urethral orifice.

? Greater vestibular glands-

? compound racemose glands

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? situated behind the bulb of the vestibule in the superficial perineal pouch

? ducts of the glands open in the vagina below the hymen.

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? Corresponds to the bulbourethral glands of male

? Urethral lacunae-

? These are pit like mucous recesses which project from the entire

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female urethra.


Applied

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? Infection of the female urinary bladder is more common due to the

shortness of the urethra.

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? Stress incontinence is associated with the funneling of the bladder

neck during normal standing usually observed in multiparous women

with symtoms of sudden dribbling of urine during increases intra-

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abdominal pressure.