3B MEDIZIN | Biologie | Bachmann Lehrmittel

VR1528/4006700/1001566
rectal ampulla
Sagittal Section
internal and external
sphincter muscles of anus
urogenital
diaphragm
Shape and Position
In terms of size (3.5 – 5 cm x 3.2 - 4.2 cm) and shape the prostate gland
somewhat resembles a chestnut and weights between 17 g and 28 g. Its
compressive elasticity is similar to that of hard rubber. It surrounds the urethra
between the base of the urinary bladder and the muscular plate spread
between the lower rami of the pubic arch (urogenital diaphragm). The two
common excretory ducts from the seminal vesicle and the ductus deferens,
called the ejaculatory duct, rise posteriorly through the prostate and lead to
the seminal colliculus of the prostate section of the urethra.
seminal vesicle
ejaculatory duct
prostate
diaphragmatic part
of urethra
ostium of
ureter
internal ostium of
urethra
prostate
prostate part of
urethra
Function
The prostate releases a thin, milky and turbid secretion containing various
enzymes, prostaglandins, citric acid and richly acidic phosphatase. It is
expelled into the urethra at the beginning of ejaculation during the male
orgasmic phase due to contraction of the prostate.
It accounts for 13 – 33 % of the entire sperm mass. The protein-cleaving
enzymes contained in it liquefy the ejaculate after 15 – 30 minutes.
Transurethral Resection (TUR)
The glandular tissue surrounding the urethra is completely removed by means of
an electroloop introduced via a resectioning instrument.
Printed in Germany
superior ramus
of pubis
body of urinary
bladder
mucosal folds
ampulla of
ductus deferens
excretory
duct
ejaculatory duct
prostate
urethra
urethral bulb
urinary bladder
rectovesticular pouch
ostium of left ureter
pubic symphysis
internal ostium of urethra
prostatic utricile
prostate
superficial dorsal
vein of penis
urethra
corpus cavernosum
penis
corpus spongiosum
penis
testis
epididymis
apex of urinary
bladder
crus of the penis
corpus cavernosum penis
corpus spongiosum penis
urinary bladder
central zone
ejaculatory duct
peripheral zone
prostatic part of
the urethra
Structure
The prostate gland can be divided into the base situated at the
top, the apex pointing downwards, a right and a left lobe, interconnected
via the isthmus of the prostate, as well as a cone-shaped
middle lobe, situated on the upper rear. The glandular tissue
which is surrounded by a firm capsule is classified into four zones:
the periurethral zone surrounding the urethra, the transitional zone, the central zone, correspondending
to the middle lobe, as well as the peripheral zone, composed chiefly of the
right and left lobes.
Posterior Aspect of Male Pelvic Organs
Ultrasound examination
Adenoma
60 % of all men over the age of 50
years suffer from a begin, nodular
enlargement of the central glandular
part, producing concomitantly
constriction of the urethra. This condition
is called a prostate adenoma,
benign prostate hyperplasia (BPH) or
also prostate hypertrophy. With advancing
age, production of the male sex hormones
continually decrease, while the latter
Symptoms
Compression of the urethra leads to the
are increasingly bound to plasma proteins, thus
socalled „prostate patient sign“ (stage I):
forfeiting their activity. A relative preponderance
attenuated urinary stream, urge for frequent
of female sex hormones begins to be manifest,
micturition, increased urine production during
the night and delayed or prolonged mic-
generating an effect primarily on the glands of the central zone
and producing the changes describbed. By means of an index
turition. During stage II formation of residual
finger introduced into the anus, the physician palpates through
urine presents additionally, while stage III
the wall of the rectum (rectal palpation) an enlarged, engorged,
ranges from an „overflow bladder“ with
smooth prostate.
hydronephrotic kidney to renal failure.
median + medial
umbilical folds
internal ostium
of urethra
prostatic ducts
inferior ramus
of pubis
bulbo-urethral
gland
seminal vesicle
Removal of a tissue sample
isthmus of the prostate
transitional zone
periurethral zone
base of the prostate
median umbilical
ligament
apex of bladder
vesical venous
plexus
vesical plexus
pubic symphysis
prostate plexus
dorsal vein of
penis
inferior epigastric
artery + vein
ductus deferens
inguinal
ligament
external iliac
artery + vein
ureter
parietal
peritoneum
Effects of Hormones
Male sex hormones (androgens) are produced by Leydig’s
interstitial cells of the testes and by the adrenal cortex under the
control of hypothalamic and anterior pituitary hormones. They
provide for development and secretory functions of the prostate.
Androgens generate an effect specifically on the peripheral zone.
The female sex hormones also present in the male organism affect
the central zone and the connective tissue of the prostate.
Vascular and Nerve Supply of Urinary
Bladder and Prostate
Rectal Palpation
left ureter
ductus deferens
superior vesicle
vein
superior vesicle
artery
autonomic
nerve fibers
inferior vesicle
vein
inferior vesicle
artery
Carcinoma
Prostate carcinoma is one of the most common
malignant tumors and one of the most common
causes of death from cancer in men. Onset is
between the age of 50 and 70 years. Unlike
the adenoma, the tumor grows generally in the
posterior or lateral parts of the prostate which
are situated near the capsule and dependent on
androgens. By means of an index finger introduced
into the anus, the physician palpates through
Metastasization
the wall of the rectum a large, asymmetrical prostate,
Distant seeding of cancer cells is effected via the lymph circulation
featuring an irregular outline and with the hardness of wood.
to lymph nodes in the vicinity of the aorta, iliac arteries and behind
Treatment as well as prognosis are based on the clinical stage,
the peritoneum as well as via the blood circulation to the bones,
which is determined inter alia by the tumor size, invasion of lymph
chiefly those of the pelvis and lumbar spine, into the liver and lungs.
nodes, distatnt metastasization and the tumor markers (prostate-specific
antigen=PSA, prostate-specific acidid phosphatase=PAP). To corroborate
the diagnosis, a tissue sample is removed through the perineal region
© 3B Scientific GmbH
(perineal fine-needle biopsy). In addition to localization of the smallest nonpalpable
tumors, ultrasound examination (sonography) is used for determi-
www.3bscientific.com
Hamburg, Germany, 1997 - 2003
nation of prostate size of residual urinary volume.
Design and text: Wilfried Hennig, Antje Gottberg
Illustrations: Holger Vaselow
›
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Prostata und Vasektomie | MEDIZINISCHE SIMULATION 91