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I. PROSTATE
Shaped more or less like a trapezoid depending on the
size. As the prostate enlarges, it becomes more heart-
shaped
PERIPHERAL Zone
Zonal Anatomy of the Prostate Constitutes the bulk of the apical, posterior, and
According to McNeal (1981), the prostate has Four lateral aspects of the prostate
(4) basic anatomic regions. Largest zone
Urethra serves as the central anatomic reference 70 % of the glandular tissue of the prostate is
point for this classification. comprised of this zone.
The anatomic/zonal regions are the following: 70% of prostate cancers are found in this zone.
Peripheral Zone, Tansition zone, Central zone, and Most commonly affected by chronic prostatitis
Anterior Fibromuscular stroma
TRANSITION Zone
Microanatomic/Histologic Architecture Surrounds the urethra proximal to the ejaculatory
The prostate is composed of 70% Glandular tissue ducts
and 30% Fibromuscular stroma Smallest of the zones
Benign Prostatic Hyperplasia (BPH) most
The stroma contribute more to the symptoms of commonly occurs in this zone
Benign Prostatic Hyperplasia (BPH)
CENTRAL Zone
Stroma is contiguous with the capsule and contracts Surrounds the ejaculatory ducts and projects under
during ejaculation the bladder base in a shape of a cone
Glands of the central zone are thought to be of
The prostate is surrounded by a capsule that is made Wolffian Duct origin because they differ
up of collagen and smooth muscle immunohistochemically and structurally from the
Actually, this is not a true capsule. In a other prostate glands
sense, its just where the fascia of the
pelvic floor and the covering of the ANTERIOR FIBROMUSCULAR STROMA
prostate converge to form, what Extends from the bladder neck to the striated
anatomist and histologists would call, a urethral sphincter
PSEUDOCAPSULE Directly continuous with prostatic capsule
Rarely invaded by carcinoma
ARTERIAL SUPPLY, VENOUS AND LYMPHATIC
DRAINAGE, AND INNERVATION
PERIPROSTATIC PLEXUS
This plexus drains to the Vesical plexus and
Arterial Supply
eventually, the Inferior Iliac Vein.
INFERIOR VESICAL Artery The Periprostatic plexus anastomoses with the deep
It is the typical arterial supply to the prostate dorsal vein of the penis and the internal iliac (also
Branches into Capsular and Urethral group of known as hypogastric) veins
arteries
Lymphatic Drainage
URETHRAL Arteries
Enter the prostatovesical junction Very important to remember especially in treating
posterolaterally and course in a perpendicular malignancy
route to the urethra
They travel toward the bladder neck with the The Obturator and Internal Iliac nodes are the
largest branches posteriorly approaching the primary sites of lymphatic drainage from the prostate.
bladder neck in the one oclock to five oclock
positions and the seven oclock to eleven The Presacral group or infrequently, the External
oclock positions. Iliac nodes may receive a small portion of the initial
These branches supply the urethra, periurethral lymphatic drainage
glands, and the transition zone of the prostate So when we do radical prostetectomy for
One that supplies the adenoma (BPH) prostate carcinoma, we not only remove the
prostate and seminal vesicles, we also go after
CAPSULAR Arteries the obturator and the internal iliac lymph nodes
This artery yield small branches that supply the
anterior prostatic capsule Nerve Supply
The capsular branches enter the prostate in a 90 The Cavernous Nerves provide sympathetic and
degree angle and provide arterial supply to parasympathetic innervation to the prostate from the
the glandular tissues pelvic plexus
Sympathetic fibers innervate the smooth muscle of
Venous Drainage the capsule and stroma for contraction
The venous drainage of the prosate converges along Parasympathetic nerves promote secretory function
with that of the bladder, the perivesical plexus by terminating in the acini
Both the bladder and the prostate, as far as their Alpha blockade
venous drainage is concerned, drains into the deep We think of drugs that are used in lower
dorsal vein of the penis urinary tract symptoms
In general, they relax the prostate to
allow smooth passage of urine.
Prostatic urethra
Closest to the anterior surface of the prostate
(fibromuscular stroma) and lined by transitional
epithelium
Enclosed in a capsule
Continuous with the stroma
Fuse with Denovilliers Fascia Figure 5. Cross section of prostate with prostatic fascial layers outlined
Anterior and anterolateral surface of the prostate including the lateral prostatic fascia (LPF), endopelvic fascia (EPF),
levator ani fascia (LAF), Denonvilliers fascia (DF), anterior lamina of
blends with endopelvic fascia
Denonvilliers fascia (ADF), posterior lamina of Denonvilliers fascia
Toward the apex: Puboprostatic ligaments suspends (PDF), neurovascularbundle (NVB), and lateral nerves (LN).
the prostate
Cradled by pubococcygeal portion of the levator ani and II. SEMINAL VESICLES
its fascia Lateral outpouching of the vas deferens
Approximately 5 cm long
Does NOT store sperm!!!
Contributes the largest portion (85%) of fluid the
ejaculate
With the ampulla of the vas deferens, it lies posterior to
the bladder.
Ureter enters the bladder medial to the tip of the SV
Denonvilliers fascia separates the posterior surface of
SV from rectum.
Not palpable on physical examination
Vasculature and innervation is similar with vas deferens
Secrete a thick alkaline fluid with fructose (an
energy for sperms), and a coagulating agent
that mixes with the sperms as they pass into the
ejaculatory ducts and urethra
Neurovascular bundle
Nerve bundles coursing along the prostate laterally
and anteriorly to the cavernosal nerves
CREMASTERIC FASCIA
derived from internal oblique
cremaster muscle is supplied by the genital branch of the
genitofemoral nerve
The fibers that mediate the cremasteric reflex travel in
Figure 7. Ampulla of ductus deferens the femoral branch of the genitofemoral nerve (L1-
(Source: Moores 7th ed, page 378)
L2). The reflex is elicited by stroking the skin on the
medial aspect of the thigh.
A. VASCULATURE AND INNERVATION
INTERNAL SPERMATIC FASCIA
BLOOD SUPPLY: from fascia transversalis
VESICULODEFERENTIAL artery (from superior vesical
artery) TUNICA VAGINALIS
lies within the spermatic fasciae
VENOUS DRAINAGE: closed sac that covers anterior, medial & lateral surface of
Scrotal vas deferens: deferential vein which drains into each testis.
the pampiniform plexus
Pelvic vas deferens: pelvic venous plexus
LYMPHATIC DRAINAGE
External and internal iliac nodes
INNERVATION:
Pelvic plexus, (sympathetic) hypogastric nerves provides
the major excitatory efferents
B. CONTENTS
Testis
Firm, mobile organ lying within the scrotum
Left is usually lower than right
Left testicle descends slightly earlier than the
right.
Upper pole is slightly tilted forward
Surrounded by tunica albuginea
Must be 3oC lower than abdominal temp
For spermatogenesis to occur
Figure 8. Blood supply of Vas deferens an Seminal Vesicle Formation of varicoceles (dilated veins) around
the testis may result to infertility
Epididymis (head, tail, body) V. PENIS
Lobules Found in the male urogenital triangle together with
Seminiferous tubules the scrotum
Rete testis Common outlet for passage of both semen and urine
Efferent ductules
Vas deferens A. LOCATION AND DESCRIPTION
Has a fixed root and a body that hangs free
C. VASCULATURE, LYMPHATICS, INNERVATION
ARTERIAL SUPPLY
External pudendal branches of the femoral artery &
scrotal branches of the internal pudendal arteries
VENOUS DRAINAGE
accompany the corresponding arteries
LYMPH DRAINAGE
Wall to the medial group of superficial
inguinal lymph nodes
Figure 14. Dorsal vasculature of the penis (Source: Campbells page 514)
LYMPH DRAINAGE
Medial group of superficial inguinal nodes
skin of the penis
Figure 12. Cross section of the penis, demonstrating the relationship NERVE SUPPLY
between the corporal bodies, penile fascia, vessels, and nerves
Pudendal nerve and the pelvic plexuses
LIGAMENTS
VI. SPERMATIC CORD
Fundiform ligament
Composed of collagenous and elastic fibers from the
A. STRUCTURES OF THE SPERMATIC CORD
rectus sheath blending with and surrounding Buck
fascia
Attaches above, in the linea alba Vas deferens
- thick-walled muscular duct from the epididymis to
Suspensory ligament the urethra
Made up of deeper fibers from the pubis
Attaches the other end of the penis to the symphysis Testicular artery
pubis - branch of the abdominal aorta (at the of L2)
Deep to the muscles of the corpora cavernosa, the
tunica albuginea and the Buck fascia fuse Testicular veins (pampiniform plexus)
- leaves posterior border of testis, plexus becomes a
B. VASCULATURE AND LYMPHATICS single vein at the level of the deep inguinal ring,
drains into the left renal vein on the left side,
ARTERIES directly to the inferior vena cava on the right
Branches of the internal pudendal artery
Lymph vessels
Deep arteries of the penis corpora cavernosa
- reach the para-aortic lymph nodes at the level on
Artery of the bulb corpus spongiosum
the side of the aorta at the level of the L1.
Dorsal artery of the penis
Autonomic nerves
- sympathetics run with the testicular artery from the
renal or aortic plexuses; affterents sensory
accompany efferent sympathetics
Cremasteric artery
a branch of the inferior epigastric artery
Appendix testis
a small pedunculated or sessile body at the upper
pole of testis
Divided by septa to form 200 to 300 lobules, each Figure 15. Testis and Epididymis (Source: Netters plate 368)
containing one or more seminiferous tubules.
VIII. EPIDIDYMIS
Seminiferous tubules open into a network of channels A firm structure lying posterior to the testis, with the vas
called rete testis deferens lying on its medial side
Composed of tightly coiled ducts which is
Small efferent ductules connect rete testis to upper continuous with vas deferens at distal cauda
end of epididymis epididymis
Leydig (interstitial) cells lie in the loose tissue is a much coiled tube nearly 20 ft (6 m) long,
surrounding the tubules embedded in connective tissue.
Responsible for testosterone production Its length is for storage and maturation of
spermatozoa
A. VASCULATURE AND LYMPHATICS
Comma shaped
It has an expanded upper end, the head, a body, and
BLOOD SUPPLY
a pointed tail inferiorly
Encapsulated within tunica vaginalis sheath
Three arterial supplies of testis
Testicular (internal spermatic) artery AREAS OF EPIDIDYMIS
Main blood supply of the testis Head (Caput)
Branch of abdominal aorta Receives spermatozoa via the efferent ducts (8-12)
Greater diameter compared to deferential and of the mediastiniumof the testis.
cremasteric arteries combined Thin myoepithelium.
Artery of vas deferens (deferential) artery Concentration of the sperm here is dilute.
Cremasteric (external spermatic) artery
Body (corpora)
Also: Vasal artery
Tail (Cauda)
Testicular artery Internal arteryinferior testicular Where sperm is stored, initially mature
artery capital artery Thicker myoepithelium than the head region
Involved in absorbing fluid to make the sperm
more concentrated.
Sinus of epididymis REVIEW QUESTIONS
Between the testis and epididymis which is lined 1. In BPH, the blood supply to the adenoma arises
with inner visceral layer of tunica vaginalis from the:
A. Superior vesical artery
B. Urethral arteries extending down the urethra
from the bladder neck
C. Capsular arteries that arise laterally
D. Neurovascular bundle