Anatomy of the prostate gland and perineum

Question 1

what Gland is doughnut shaped and is the size of a golf ball and is the largest accessory gland of the male reproductive system

where is it located

Answer 1

Prostate gland

Located inferior to the urinary bladder and surrounds the prostatic urethra

Question 2

the prostate Gland is located inferior to the urinary bladder - what does it surround

Answer 2

prostatic urethra

Question 3

what are the two parts to the prostate gland

Answer 3

posterolateral glandular -2/3 and anterior fibromuscular one third

superiroly, base is related to the neck of the bladder

inferiorly the apex of the prostate rests on external sphincter of neck of bladder and deep peritoneal muscles

Question 4

what space separates the anterior surface of the prostate from the pubic symphysis

Answer 4

retroperitoneal fat in the retropubic space - cave of retries

Anterior to the urethra is the narrow fibromuscular isthmus.
Posterior surface related to the ampulla of the rectum.
Inferolateral surfaces related to the levator ani muscle.

Ejaculatory ducts enter the upper posterior part to open into the urethra, on either side of the prostatic utricle.

Question 5

what is the prostatic sinus

Answer 5

depression on each side of the urethral crest ( midline ridge)

Question 6

where do you find the seminal colliculus

Answer 6

eminence in the middle of the urethral crest

Question 7

prostatic arteries are derived from what arteries

Answer 7

branches of internal iliac artery
inferior veiscal
internal pudendual and middle rectal arteries

Question 8

veins are found between the true fibrous capsule and false prostatic sheath around the side of the base of the prostate. What is the plexus called

Answer 8

prostatic plexus - veins receive the dorsal vein of the penis and drain into internal iliac veins

also continues with internal veterbral venous plexus infant of vertebral bodies within the neural canal - this explains why carcinoma of the prostate spreads readily to pelvic bone and vertebrae - these veins are valveless and constitute the valves vertebral veins of batson

Question 9

how many capsules does the prostate have

Answer 9

2
true capsule - dense and neruovascular - contains the prostatic plexus of veins and nerves
a false one - surrounds capsular prostatic sheath composed of condensed visceral layer of pelvic or extra( retro) peritoneal fascia - blends with the retrovesical septum

Question 10

How many lobes of the prostate are there

how many lobules and what are they called

Answer 10

2 - right and left divided into 4 lobules -by relationship with the urethra and ejaculatory ducts
- inferoposterior ( lower posterior lobule)
- inferolateral ( lower lateral) lobule
superomedial
anteromedial

Question 11

3 zones of the prostate - preferred by clinicians

Answer 11

peripheral zone
central zone
transition zone

Question 12

what does the prostate develop from

do individual prostatic glands retain their own ducts?

Answer 12

from urethral epithelium into surrounding wall of urethra
they enlarge the wall

yes they empty independently into prostatic sinuses on posterior aspect of urethral lumen

Question 13

what does the prostate secrete

Answer 13

milky acidic fluid , together with seminal vesicle contributes to volume of the semen during ejacualtion

Question 14

what condition are the lateral lobes enlarged usually affected and common between middle aged men and can affect the median lobe which could obstruct prostatic part of the urethra and impeded uriantion increasing the risk of bladder infection ( cystitis) as well as kidney damage)

Answer 14

hypertrophy of the prostate

- benign hypertrophy

Question 15

how can you check for the hypertrophy of the prostate

Answer 15

rectal examination - more readily palpable to examine enlargement in a full bladder via rectum

Question 16

where do metastases of prostatic cancer spread to via lymphatic route initially and to internal iliac and sacral lymph nodes and via venous route following the internal venous plexus to where

Answer 16

vertebrae and brain

Question 17

what Is a prostatectomy

Answer 17

TURP - all or part removed being careful not to damage prostatic urethra , very enlarged prostatectomy carried out retropubically - capsule

Question 18

what is TURP

Answer 18

transurethral resection of the prostate - preserves nerves and BV associated with true capsule that pass to and from the pens increase patients chance of sexual function as rwell as restoring normal urianry control

Question 19

what could radical prostatectomy involve

Answer 19

Radical prostatectomy could involve the removal of the prostate with the seminal vesicle, ejaculatory ducts and terminal parts of the deferent ducts.

Question 20

what is the perineum

Answer 20

The region of the body that lies between the upper part of the medial surface of the thighs and the buttocks, extending posteriorly from the coccyx to the pubis anteriorly and superiorly (deep) up to the pelvic diaphragm.

It includes the anus and external genitalia:
the penis and scrotum of the male and the vulva/vagina of the female.

Question 21

the roof of the perineum is formed by what

Answer 21

pelvic diaphragm -

Question 22

what are the two triangles joined by a line between the 2 ischial tuberostitees dividing the perineum into 2

Answer 22

urogenital triangle anteriorly

the anal triangle postieroly

Question 23

the midpoint of the line joining the ischial tuberostiites is the location of what

Answer 23

the central perineal body or tendon

Question 24

Perineal fasciae consists Superficial and Deep layers

the superficial layer is made of 2 layers what are they
difference between men and women

Answer 24

superficial fatty layer

females - fatty tissue of labia major and mon pubis and goes anteriorly to lower anterior abdominal wall

males - diminished and replaced in the penis with smooth muscle ( darts) and goes lateral and superiorly with campers facias of lower abdominal wall

Question 25

Some deep fascia stuff

Answer 25

Deep membranous layer of superficial perineal fascia (Perineal or Colles fascia).
Extends laterally and attach to the fascia lata of the thigh.

In males: continues anteriorly with the Dartos fascia of the penis and scrotum, becomes continuous superiorly with the Scarpa’s fascia of the lower anterior abdominal wall.
In females: it also becomes continuous with the Scarpa’s fascia of the lower anterior abdominal wall.

Deep layer of Perineal Fascia (Investing or Gallaudet Fascia).
Invests the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles.
Laterally attached to ischiopubic rami.
Anteriorly fuses with the suspensory ligament of the penis/clitoris and continues superiorly with the deep fascia of the lower anterior abdominal wall.

Question 26

in the urogenital triangle - a perinoenal membrane stretches over the anterior part of pelvic outlet - urogenital hiatus

does the urethra perforate this

Answer 26

yes

Question 27

the superficial perineal pouch is a space between the perennial fascia and perineal membrane - what binds this laterally

Answer 27

ischiopubic rami

Question 28

in males what structures are contained in the superficial perineal pouch

Answer 28

root of penis
proximal part of spongy urethra
superficial transverse perineal muscles
deep perineal branches of internal prudential vessels and nerves

Question 29

in females what structures are contained in the superficial perineal pouch

Answer 29

clitoris and associated muscle ( ichiovavernosus)
bulb of vestibule
greater vestibular glands
same as male last 2

Question 30

what is the deep perineal pouch

Answer 30

space between perineal membrane ifnerioly and inferior facia of diaphragm superiorly and obturate interns muscle laterally.

Question 31

what is contained in both sexes in the deep perineal pouch

Answer 31

centrally the urethra
external sphincter muscles above the centre of perineal membrane surrounding the urethra
anterior extension of the ischia-anal fat pads

Contents in Males:
Intermediate part of the urethra, the narrowest part of the male urethra.
Deep transverse perineal muscles.
Bulbo-urethral glands.
Dorsal neurovascular structures of the penis.

Contents in Females:
Proximal part of the urethra.
Deep transverse perineal muscles?.
Dorsal neurovasculature of the clitoris.

Question 32

what can cause rupture of the membranous part of the urethra

Answer 32

trauma and fracture of pelvic grille with separation of Pubic symphysis and puboprostatic ligament

leads to extravasation of urine and blood into the deep peritoneal pouch - fluid may go superior to urogenital hiatus and distribute extraperitoneally around prostate and bladder

Question 33

what does rupture of the spongy part of the urethra 9 particularly at the blue of the penis and corpus spongisum due to trauma or blow or incorrect transurethral cathertisation , rest to

Answer 33

urine extravasating into superficial perineal pouch - along peritoneal fascia - may go to scrotum

The urine cannot pass into the thighs because the membranous layer of the superficial perineal fascia blends with the fascia lata just distal to the inguinal ligament.

The urine also cannot pass posteriorly into the anal triangle because the superficial and deep perineal fascia are continuous with each other around the superficial perineal muscles and with the posterior edge of the perineal membrane.

Rupture of blood vessels into the superficial perineal pouch will result in similar containment of blood in the superficial perineal pouch.

Question 34

where is the ischia anal fossa located

Answer 34

each side of anal canal - wedge shaped either side

apex of this fossa is superiorly to leavator and muscle filled with fat and loose connective tissue

Question 35

how to the 2 ischia anal fossa communicate with each other

Answer 35

via the deep perineal pouch

Question 36

boundaries of the ischia anal fossa

Answer 36

Extends into the urogenital triangle superior to the perineal membrane as the Anterior recesses of the Ischio-anal fossae.

Boundaries are:
Laterally by the ischium and overlapping inferior part of the obturator internus, covered with obturator fascia.

Medially by the external anal sphincter.

Superiorly by a slopping roof formed by the levator ani muscle.

Posteriorly by the sacrotuberous ligament and gluteus maximus.

Anteriorly by the bodies of the pubic bones

Question 37

what is contained in the ischia anal fossae

Answer 37

Filled with fat body of the ischio-anal fossa, which provide support for the anal canal.

Fibrous bands that traverse the fat bodies.

Neurovascular structures including the inferior anal (rectal) vessels and nerves.

Cutaneous nerves.

Perforating branch of S2 and S3.

Perineal branch of S4 nerve.

The pudendal canal (Alcock canal) and its neurovascular bundle in the lateral wall of ischio-anal fossae.
Internal pudendal vessels.
Pudendal nerve.
Nerve to the obturator internus.

Question 38

ischio anal and peri-anal abscesses

Answer 38

May be site of infection leading to formation of painful ischio-anal abscesses.

Shows as fullness and tenderness between the anus and the ischial tuberosity.

Infection may reach the ischio-anal fossae in the following ways:

After cryptitis (inflammation of the anal sinuses.
Extension from a pelvirectal abscess.
After a tear in the anal mucous membrane.
From a penetrating wound in the anal region.
From anal fissure.

An abscess in one fossa my spread to the other due intercommunication posteriorly via the deep post-anal space.