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 ofurogenital 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 situatedabout 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 rectalexamination 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 sulcusinto 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 trigonumvesicae.
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 arecontinuous.
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 CapsuleFormed 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 peripheryFascia 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 eachside 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 fromcolliculus behind the median lobe.
STRUCTURE OF PROSTATE GLAND
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Consist of 1/4th fibrous, 1/4th muscular and 2/4th glandulartissue.
? 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 byradiating fibres. Spaces between these fibres occupied by
?follicles of the gland.
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?There are transversely oriented arched striated musclefibres 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 glandsBLOOD SUPPLY
Arterial supply :
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1. Inferior vesical artery2. 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 abovewith 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 nodes3. 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 splanchnicnerves conveying preganglionic fibres from S2, S3, and
S4.(secretomotor to gland)
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AGE CHANGES IN PROSTATE GLANDIn 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 foldsdisappears 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 urethraThe 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 subdividedinto:
? The bulbar urethra which is
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more proximal, surrounded by
the Bulbospongiosus muscles
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and lie entirely within theperineum.
? 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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pelvisproximal 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 andpasses 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 urethraPreprostatic urethra
? approximately 1 cm in length.
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? extends from the base of the bladderto 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 thepreprostatic 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 thereis 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 maleurethra.
? 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, duringpassage 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 cmSpongy (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 directedforwards. 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 theseminal 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 linedby stratified columnar
epithelium.
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3. Spongy urethra up to navicular
fossa is lined by stratified
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columnar epithelium. Thenavicular 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 ismore likely to be lacerated.
Lumen of Urethra on cross section
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? At the internal orifice- crescenticwith 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 bladderneck during normal standing usually observed in multiparous women
with symtoms of sudden dribbling of urine during increases intra-
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abdominal pressure.