ANATOMY'OF'PROSTATE'

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DEVELOPMENT:''
PROSTATE gland:
Endodermal*outgrowth*of*the*prostatic*urethra.*
It$ is$ an$ accessory gland of$ male reproductive
Stroma*and*smooth*muscle*from*the*smooth*muscle*around.*
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system,$which$surrounds$the$prostatic urethra.$
Accessory*male*reproductive*organ.*
1. Site:!
Contributes*to*30%*seminal*fluid.*
It$lies$in$the$lower part of$the$lesser pelvis behind$the$
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inferior$border$of$the$symphysis pubis, in$front$of$the$
SITE:'
rectum$&$below$neck$of$the$bladder.$
Lower*part*of*lesser*pelvis*behind*inferior*border*of*symphysis*pubis,*in*front*of*
rectum*and*below*neck*of*bladder.'
It$ contributes$ to$
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3 0 %$ o f $ t h e$
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seminal fluid.!
DIMENSIONS:'
AP:*2cm*
Vertical:*3cm*
SP$
Transverse:*4cm*
R$
2cmx3cmx4cm*
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CAPSULES:'
INNER'True'capsule:*fibroImuscular*
structure.'
OUTER'False'capsule*(prostatic*sheath):*
condensed*visceral*pelvic*fascia.*
Between*these*two*capsules*lies*the*prostatic*venous*plexus.*
*
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 It$ is$ convex and$ lies$ behind$ the$ lower part of$ the$
symphysis pubis,$ retro% &pubic% space% of% Retzius$ &$
prostatic$venous$plexus.$$
Its$ upper$ part$ is$ connected$ to$ the$ pubic bodies by$
SHAPE,'DESCRIPTIONS,'&'RELATIONS:'
pubo -prostatic ligaments.$

Apex:*inferiorly.**rests*on*superior*
fascia*of*urogenital*diaphragm*(roof*of*deep*perineal*pouch)'
Base:*superiorly*(below*neck*of*bladder)**contains*part*of*prostatic*venous*
plexus.'
Anterior*surface**lies*behind*lower*part*of*the*symphysis*pubis,*retroI*pubic*
space*of*Retzius*and*prostaticvenous*plexus;*connected*to*pubic*bodies*by*puboI
prostatic*ligaments.'
2*Rt.*And*Lt.*inferoIlateral*surfaces**convex*and*related*to*levator*ani*(levator*
prostate).'
Posterior*surface*I**flat*and*related*to*ampulla*of*rectum*and*separted*from*it*by*
rectoIvesical*pouch*(fascia*of*Denonvilliers).*Near*its*upper*border,*pierced*by*2*
ejaculatory*ducts.'
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! FASCIA'OF'DENONVILLIERS:'
The$ prostate$ is$ easily$ palpated$ by$ a$ finger$ in$ the$

rectum.$$

DRE

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Fascia&of&Denonvilliers!
Prostatic*sheath*(red)*touches*fascia*of*Denonvilliers*(orange).'

The*autonomic*innervation*of*the*corpora*of*penis*runs*close*to*posteroIlateral*
" The$recto -vesical fascia is$attached$above$to$the$oor$of$
aspect*of*the*prostatic*capsule*"*at*risk*for*damage*in*radical*prostatectomy*
surgery*(removal*of*prostate*with*both*capsules*of*prostate*along*with*the*lymph*
recto -vesical pouch and$below$to$the$perineal body.$
nodes).'

The$prostatic sheath is$touching$with$the$fascia$of$

Denonvilliers.$
The$autonomic innervation to$the$corpora$of$the$
penis$ are$ running$ close$ to$ the$ posterolateral$
aspect$of$the$prostatic capsule.$

prostatic$capsules%&$lymph$nodes).$
The$neural$bundle$is$located$posterior$to$the$prostate.$
They$ are$ between$ the$ prostatic capsule (pelvic$ fascia)$
anteriorly,$ fascia$ of$ Denonvilliers$ posteriorly$ &$
levator fascia inferiorly.$

The*neural*bundle*(star*in*
diagram)*located*posterior*to*
prostate.'
Located*anterior*to*prostatic*
capsule,*fascia*of*Denonvilliers*
posteriorly,*levator*fascia*
Inferiorly.!'
b. Lobes:
5
"!common!cause!of!erectile!
1. Anterior:
in front of prostatic urethra (fibro-muscular)
dysfunction/!impotence!during!
transurethral*prostatectomy*
2. Rt.
And Lt. lateral lobes: lateral to urethra.
(done*in*BPH).'
3. ' Posterior lobe: lies behind the prostatic urethra, but
' below the ejaculatory ducts. (cancer)
RELATIONS'OF'PROSTATE:'
4. Middle
lobe: between the upper part of prostatic
Anterior:*symphysis*pubis*
and the ejaculatory ducts. (Benign prostatic
urethra
Posterior:*rectum*
hyperplasia
Inferior:*its*apex*is*rested*on*deep*perineal*pouch*(superficial*fascia*of*urogenital*
(BPH)
diaphragm)*
When enlarged it produce uvula vesicae (elevated
Superior:*its*base*is*related*to*neck*of*bladder.*
Laterally:*levator*ani.*
mucosa of the lower trigone obstruction to flow of
*
urine.
LOBES'OF'PROSTATE:''5'LOBES'(anatomically)'

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Anterior*lobe**front*of*prostatic*urethra*(pic*3).*
Lateral*LOBES*I**lateral*to*urethra*(pic*2).*
Posterior**behind*prostatic*urethra,*BELOW*ejaculatory*ducts*(pic*3)*"*
CANCER.*
Middle**between*upper*part*of*prostatic*urethra*and*ejaculatory*ducts*"*BPH.*
! When*enlarged,*produces*UVULAE'VESICAE'(elevated'mucosa'of'
lower'trigone)'"'obstruction'to'flow'of'urine.'

 It$contains$70%$$glandular$pros
e$ constitutes$ the$ bulk$ of$ apical,$ 75%$of$all$prostate$carcinoma.$

eral aspects$of$the$prostate.$
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glandular$prostate$gland.$$
ZONES'OF'PROSTATE:*used*in*pathology*
e$carcinoma.$

not
gn

Superior$view$

This$ zone$ does not

u n* d e r g o$ b e n i g n
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hyperplasia.
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PERIPHERAL'ZONE:'*bulk*of*apical,*posterior,*lateral*aspects*of*prostate.**
! 70%*glandular*tissue*of*prostate.*
! 75%'carcinomas*(does*not*undergo*benign*hyperplasia)*
CENTRAL'ZONE:'*
! 25%*glandular*tissue.*
! Surrounds*ejaculatory*ducts.*
! 10%'of'carcinomas.'
TRANSTIONAL'ZONE:'='MIDDLE'LOBE.'
! Surrounds*urethra*and*above*ejaculatory*ducts.'
! 5%'carcinomas.'
! Main'site'for'BPH.'
ANTERIOR'ZONE:'='Anterior'lobe'
! Fibromuscular,*nonIglandular*tissue.'
! Extends*from*neck*of*bladder*to*external*urethral*sphincter.'

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BLOOD'SUPPLY:'
Inferior*vesical**anterior*division*of*internal*iliac*artery.'
Middle*rectal'
Internal*pudenal'
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VENOUS'SUPPLY:'
Prostatic*venous*plexus**SANTORINI'PLEXUS.'
Present*only*in*front*and*sides*of*the*prostate.'
Drains*into*internal*iliac*veins"which*communicates*with*internal*vertebral*
venous*plexus*through*lateral*sacral*veins*(valveless).'

 Responsible'for'spread'of'cancer'to'lumbar'vertebrae'and'cranium.'
NERVE'SUPPLY:'
Inferior*hypogastric*(pelvic)*plexus.*
Lateral*to*rectum.*
PARASYMPATHETIC:*pelvic*splanchnic*nerves**S2,3,4*"*SECRETION*(active*
gland).*
SYMPATHETIC:*T11,12;*L1,2;*I*sacral*sympathetic*chain*+*hypogastric*nerves*"*
EXPULSION*OF*PROSTATIC*FLUID.*
Ejaculation'is*controlled*by*the*SYMPATHETIC*NS*#*contraction*of*SM*stroma*
of*the*bladder*neck*(sphincter'vesicae)*#*expulsion*of*prostate*content*and*
closure*of*bladder*neck,*preventing*retrograde'ejaculation'(semen*enters*
bladder;*can*also*be*caused*by*injury*to*nerves*in*retroperitoneal*
lymphadenectomy*in*PCa).'
LYMPATIC'DRAINAGE:'

Internal*iliac*#*ParaIaortic*nodes.'
Also*to*sacral*and*external*iliac*#*paraIaortic*LN.'

#'HISTOLOGY:'

Numerous*branched*glands*supported*with*a*dense*SM*and*CT*stroma.'
PSEUDOZCOLUMNAR'EPITHELIUM'of*varying*height:'
! Contain*apical*secretory*granules.'
! BASAL*CELLS*found*between*columnar*cells*for*regeneration*of*epithelium.'
! Prostatic*concretion*formed*by*condensed*prostatic*secretions.'
! Their*numbers*increase*with*age.'

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