I- INTRODUCTION :
The prostate gland is an odd glandular mass, median, situated in the pelvic cavity at the junction formed by the urethra and the sperm ducts.
II- Anatomy Descriptive :
1- Situation :
It is located :
– below the bladder
– above the perineal floor
– in front of the rectum between the levator ani muscles Each side behind the pubic symphysis.
2- Form :
It has a shape of a chestnut or a flattened cone back and forth, to lower apex, its axis is obliquely downwards and forwards.
3- Color :
Whitish or whitish-gray or pale pink.
4- Consistency :
Farm and regular, endured more in the elderly, easy to enjoy by DRE.
5- Weight :
20 at 25 g.
6- Dimension adults :
– Height : 30mm
– Width : 40 mm
– Thickness : 25 mm
7- Description :
It describes him 4 faces, a base, 1 Mountain peak.
→ The faces stand out in :
- previous : flat and vertical
- posterior : more oblique, more convex with a median dividing depression 2 lateral lobes.
- 2 lateral surfaces : broad and rounded.
→ The upper base or face : divided by a projecting bead, cross in :
- Versant previous urethrovesical
- Versant post, genital : has a transverse groove into which penetrates seminars vesicles and vas deferens which converge to form the ejaculatory ducts.
→ The top-billed or prostate, rounded back and forth, and responds to the emergence of the urethra.
8- The internal constitution :
The prostate is completely wrapped in a tissue capsule, thin and adherent sending towards many partitions between the lobules coming together in a number of glandular masses forming "prostatic lobes". Several canals pass through such as the urethra and the ejaculatory ducts.
The lobes are different from conventional manner :
– 1 anterior lobe, pré-urethral : it is reduced.
– 2 lateral lobes : behind the urethra, behind the sperm ducts.
– 1 median lobe : or pre-sperm, situated in front of the ejaculatory ducts. The glandular lobes are formed by 30 at 40 prostate glands.
9- The means of fixity :
The prostate is held in place by :
– Its adhesion with the base of the bladder.
– The crossing of the urethra and sperm ducts.
– His connections with the wall of the prostate bed
III- REPORTS OF PROSTATE :
The reports of the prostate should be studied :
– Inside the box
– Outside of the box.
A- The compartment of the prostate :
The prostate is contained in a box whose cellulignin fiber walls consist of :
– Forward : pre-prostatic fascia that ends up in the ligaments Pubo- prostate and below the transverse ligament of the pelvis.
– Backward : the recto-aponévrose vésicale the booth du rectum and Soudeur latéralement aux lames wash pubiennes.
– Laterally : the lower part of the blades sacro-pubic which down to the fascia average perineum and back up on the sides of the bladder.
– Up : bladder and by the fibrous connective tissue that binds the organ to the base of the prostate.
– Below : the mean plane of the perineum.
B- prostate reports within the prostatic area :
Prostate between related :
– The prostatic portion of the urethra
– The smooth muscle of the urethra sphincter.
– The upper part of the peri-prostatic sphincter muscle, streak of the urethra
– Venous peri-prostatic elements represented by the convergence of the anterior dorsal bladder veins of the penis. This convergence forms the Santorini plexus
C- By & rsquo; through the prostate bed, prostate between related :
– Forward :
- The lower part of the pubic symphysis
- A retro-symphyseal bladder
- one or 2 fat veins
- Greasy arteries and reverse symphyseal (collateral branches of the shameful internal artery)
- The plexus of Santorini
- The muscle of the urethra sphincter
- Some pre-prostatic veins
– Laterally : The levator ani.
– Backward : the rectum, seminal vesicles, termination of the vas and the pedicles neurovascular.
– Up : the bladder, terminating sperm ducts (seminal vesicles and ampullae).
– Below : The average level of the perineum, rectal elbow.
IV- VASCULARIZATION PROSTATE :
1- The arterial supply :
It is under the control of the iliac artery and provided by the following arteries are branches of the anterior trunk of the internal iliac.
a- The lower bladder artery :
give usually :
– One or more vesico-prostatic branches which penetrate the base of the prostate.
– Prostatic branches that cover the side faces and posterior prostate.
b- The internal pudendal artery :
Participates in vascularization.
c- The average rectal artery :
Incidentally participates in the vasculature of the prostate.
2- Venous vascularization :
Veins flow forward and laterally into the prostatic venous plexus and back in seminal plexus ; while the blood of the plexus is led by bladder veins to the internal iliac vein.
3- The lymphatic vasculature :
The lymph collectors prostate accompany the vessels and are distinguished 4 pedicles :
– Pedicle external iliac : tributary of a lymph node under venous external iliac.
– Pedicle internal iliac : along the prostatic artery to a hypogastric ganglion.
– posterior pedicle : ends either in a node located within the 2e sacral foramen, or in the lymph nodes of the promontory.
– inferior pedicle : descends from the anterior surface of the prostate wins the internal pudendal artery and ends in an internal iliac lymph node.
N.B : Lymph prostate are widely anastomosing with those of the bladder, the deferential bulb, seminal vesicles and rectum.
4- Innervation :
The nerves of the prostate are the hypogastric plexus.
Course of Dr DOUS SAID – Faculty of Constantine