Prostate

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Prostate Anatomy:

Prostate Anatomy

Prostate Anatomy:

Prostate Anatomy

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Introduction/General Information Attached inferiorly to urinary bladder by ligaments Posterior to pubic symphysis Surrounds superior portion of urethra Anterior to rectum (palpation, ultrasound) Conical shape

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F. Walnut sized 4 cm trans x 2 cm A/P x 3 cm Sup/Inf G. Lightly encapsulated 1. Fibrous connective tissue 2. Smooth muscle 3. Capsule extends into lobes

II. Prostate Gland: Detailed Anatomy:

II. Prostate Gland: Detailed Anatomy A. Largest male accessory gland B. Located in subperitoneal compartment (between pelvic diaphragm & peritoneum)

Lobes of the Prostate:

Lobes of the Prostate Anterior lobe Median lobe Lateral lobe Posterior lobe

Zones of the Prostate:

Zones of the Prostate Peripheral Central Transitional

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Prostate Gland: Detailed Anatomy C. Enclosed in fascial sheath (aka: prostatic sheath) 1. Inferiorly, sheath is continuous with superior fascia of urogenital diaphragm 2. Posteriorly, sheath forms part of retrovesical septum

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Prostate Gland: Detailed Anatomy D. Double Capsule 1. Fibrous portion contacts gland 2. External capsule formed by pelvic fascia 3. Venous plexus lies between

Male Reproductive System, Posterior View:

Male Reproductive System, Posterior View

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Detailed Anatomy, contined … E. Conical shape with base (sup), apex (inf), four surfaces 1. Surfaces: posterior, anterior, right & left inferolateral 2. Base (aka: vesicular surface): superior a. Attached to neck of urinary bladder b. Prostatic urethra enters middle of base close to anterior surface

Prostate Anatomy:

Prostate Anatomy Prostatic Urethra

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Detailed Anatomy, contined … 3. Apex: inferior a. Rests on superior fascia of urogenital diaphragm muscle b. Associated with sphincter urethrae c. Contacts medial margins of levator ani muscles

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Detailed Anatomy, contined … 4. Posterior surface: triangular, flat 5. Anterior surface: narrow, convex 6. Inferiorolateral surfaces a. Meet with anterior surface b. Rest on levator ani fascia above urogenital diaphragm

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Detailed Anatomy, contined … F. Lobes of the Prostate 1. Divisions are arbitrary, indistinct 2. Usually divided into a. two lateral lobes b. one median lobe c. anterior and posterior lobes

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Lobes of the Prostate, continued … 3. Median lobe a. Lies posterior and superior to prostatic utricle and ejaculatory ducts b. May project into urinary bladder c. Utricle lies within lobe 1. Vestigial remains of uterine homolog 2. Sometimes called “uterus masculinis”

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Lobes of the Prostate, continued … 4. Lateral lobes a. Comprise the greatest mass of the gland b. Contain most secretory tissue c. Are continuous posteriorly 5. Glandular tissue with varying amounts of fibrous tissue

Lobes of the Prostate, continued …:

Lobes of the Prostate, continued … Prostate Gland in situ

Detailed Anatomy, continued …:

Detailed Anatomy, continued … G. Blood & lymph 1. Arteries derived from: a. Internal pudendal artery b. Inferior vesical artery c. Middle rectal artery

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Blood & Lymph, continued … 2. Veins a. Form venous plexus b. Drain into internal iliac veins c. Communicate with vesical & vertebral venous plexuses

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Blood & Lymph, continued … 3. Lymphatics a. Most terminate in internal iliac & sacral nodes (unable to palpate) b. From posterior: to external iliac nodes (unable to palpate )

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Detailed Anatomy, contined … Glandular tissue 1. 30 - 50 different glandular elements a. Serous glands b. 20 - 30 ducts empty into prostatic urethra 2. Most are posterior & lateral to urethra

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Blood & Lymph, continued … 3. Prostatic secretions a. Thin, milky, alkaline (looks like skim milk) b. Discharged at ejaculation c. Make up ~ 1/3 of semen

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Detailed Anatomy, continued … Prostate size changes 1. Small at birth 2. Enlarges at puberty 3. Maximum at about 13 4. Progressive enlargement after 40 5. Sometimes: undergoes atrophy

III. Pathology:

III. Pathology A. Benign prostatic hypertrophy (BPH): 1. Affects ~90% of men >50

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BPH, continued … 2. Common cause of urethral obstruction: causes a. Nocturia b. Dysuria c. Urgency d. Back-pressure effects e. Complete obstruction can occur

Pathology, continued …:

Pathology, continued … B. Prostate cancer 1. Most common cancer in males

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2. Metastasizes via blood (hematogenous) or lymph (lymphogenous) 3. Common sites: vertebrae, pelvis a. Via venous plexus surrounding Prostate b. Bone or direct metastasis most common

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Pathology, continued … Prostatitis (accompanied by cystitis) 1. Inflammation of gland 2. Gland enlarges, becomes tender 3. Causes: gonorrhea? Other UTI’s? STD’s? 4. May require antibiotics, massage 5. Symptoms: chills, painful urination, back pain

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Pathology, continued … Prostatic concretions (aka: corpora amylacea [starch bodies]) 1. Small spherical or ellipsoid bodies 2. Number increases with age 3. May become calcified as male ages 4. May simulate carcinoma

Digital Rectal Exam:

Digital Rectal Exam

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Pathology, continued … E. Rarely, prostatic abscesses develop 1. Frequently caused by gonorrhea 2. May rupture through to rectum, bladder, perineum 3. Other causes: a. Urethritis b. Epididymitis

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