Seminal Vesicles and Prostate Gland S-IV RM25

Seminal vesicles and Prostate gland S-IV RM25 Learninig Objectives  At the end of the lecture student will able : To define the seminal vesicles and prostate of male reproductive system. Explain the relation and anatomical position of these gland. Discuss the clinical associations of these gland  Seminal vesicles Thin walled lobulated sacs situated b/w bladder & rectum. Each vesicle is about 5 cm long. Applied base of bladder above prostate. Directed upwards & laterally. Produce 60% of seminal fluid. Their tops are just covered by peritoneum of rectovesical pouch. Rectovesical fascia lies behind them. Each lies lateral to ampulla of the ductus deferens of its own side. At lower end of ampulla behind prostate the duct of seminal vesicle join ductus to form ejaculatory ductus. Arterial supply of seminal vesicle  Supplied by branches from.› Inferior vesical arteries. › Middle rectal arteries  Prostate  Definition  Accessory gland of male reproduction . Secretion of prostate , seminal vesicles & bulbourethral glands form seminal fluid.  Largest male accessory gland Located in lesser pelvis Gross Features:  Conical shape with:› base (sup)› Apex (inf),  Surfaces: › Posterior› Anterior› right & left inferolateral  Relations  Attached inferiorly to urinary bladder by ligaments Posterior to pubic symphysis  Surrounds superior portion of urethra Anterior to rectum Anterior Surface  Ant. Surface lies at the back of retropubic space Connected to body of pubic bone by puboprostatic ligament. Posterior Surface:  Post.surface lies anterior to rectum Separated from it by retrovesical fascia(Denonvillier’s fascia) Ejaculatory duct pierces this surface Inferolateral surfaces are related to the inferior fibres of levator ani  Base (aka:vesicular surface): superior › Attached to neck of urinary › Prostatic urethra enters middle of base close to anterior surface› bladder Apex: inferior › Prostatic urethra emerges from front of apex to become membranous urethra› Surrounded by sphincter urethrae › Contacts medial margins of levator ani muscles Capsule of prostate gland  Double Capsule: True capsule: Formed by a thin layer of connective tissue at the periphery False Capsule: Lies outside the true capsule and is formed by condensation of the pelvic fascia B/W these lies the prostatic plexus of veins Lobes of the prostate gland  Anterior lobe  Connects the two lateral lobes in front of the urethra Contains little or no glandular tissue Rare site for adenoma Posterior lobe  Connects the two lateral lobes behind the urethra Lies behind median lobe Site of origin for primary carcinoma Adenoma never occurs here Median lobe  Lies posterior and superior to prostatic utricle and ejaculatory ducts May project into urinary bladder  Utricle lies within lobe Vestigial remains of uterine homolog Sometimes called “uterus masculinis” Common site for adenoma LOBES  The "lobe" classification is more often used in anatomy. Histological zones  Peripheral zone:  Upto 70% of prostate  Surrounds distal urethra Accounts for 70-80% of prostatic cancer Central zone:  Upto 25% of prostate Surrounds ejaculatory duct Accounts for 2.5% of prostate.cancers  Transition zone:  Upto 5% of prostate area Surrounds proximal urethra Accounts for 10-20% of prostatic cancers Blood supply of Prostate  Arteries derived from:  a. Internal pudendal artery b. Inferior vesical artery c. Middle rectal artery  Veins:a. Form venous plexus  b. Drain into internal iliac veins c. Communicate with vesical & vertebral venous plexuses Lymphatics: a. Most terminate in internal iliac & sacral nodes (unable to palpate) b. From posterior: to external iliac nodes  Prostatic secretions  Thin, milky, alkaline (looks like skim milk) Discharged at ejaculation c. Make up ~ 1/3 of semen Age changes in prostate  Grows throughout life Responsible for BPH  Small at birth Enlarges at puberty  3. Maximum at about 13 4. Progressive enlargement after 40 5. Sometimes: undergoes atrophy  Benign Prostatic Hyperplasia(BPH):  Affects ~90% of men >50 years of age Characterizied by Hyperplasia of prostatic stromal and epithelial cells Forming discrete nodules in the periurethral region of the prostate, compressing urethra and causing symptoms of:› urinary hesitency › frequent urination› Dysuria › urinary retention  BPH  Diagnosis Rectal examination transrectal US (TRUS) PSA level. Drug treatment  Alpha blockers,5 alpha inhibitors. Surgery…..TURP(Transurethral resection of prostate). Shown in the diagram. Prostate cancer  Most common cancer in males  Metastasizes via blood (hematogenous) or lymph (lymphogenous)  Common sites: vertebrae, pelvis a. Via venous plexus surrounding prostate  b. Bone or direct metastasis most common PSA (Prostate Specific Antigen)  Glycoprotein, kallikrein related serine protease  Produced by secretory epithelium, drains into ductal system cleaves and liquefies seminal coagulum formed after ejaculation The traditional PSA threshold level of 4.0 ng/mL is considered reasonable for further evaluation of Prostate Cancer  Annual PSA testing recommended for:› men 50+› men 40+ at increased risk The age to begin screening is linked to risk: › At age 50 years for average-risk men› At age 45 years for higher-risk men (African American ethnicity or first-degree relative with prostate cancer before age 65 years)› At age 40 years for appreciably higher-risk men (multiple family members diagnosed with prostate cancer before age 65 years) Prostate cancer screening is not recommended in men with a life expectancy of less than 10 year

Seminal Vesicles and Prostate Gland S-IV RM25

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