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Embryology, Anatomy, and Physiology of the Male Reproductive System
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Ejaculatory ducts: ~2 cm longBegin at the junction of the seminal vesicles and vas deferens.Open into the prostatic urethra at the verumontanum at an acute angle to prevent urinary reflux into the ducts.
The Infertile Male
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Thoraya Ammar, C. Jason Wilkins, Dean C.Y. Huang, Paul S. Sidhu
Despite the low overall incidence of ejaculatory duct obstruction, correct diagnosis is important, as it can be treated by transurethral resection of the ejaculatory duct. This is followed by the appearance of spermatozoa in the ejaculate in approximately 50%–73% of cases with a 25% pregnancy rate [20].
Prostate cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Jurgen J Fütterer, Fillip Kossov, Henkjan Huisman
The prostate is a small wedge-shaped gland situated directly caudal to the bladder. The prostate gland envelops the prostatic urethra and ejaculatory ducts. The seminal vesicles are paired grapelike pouches filled with fluid that are located caudolateral to the corresponding vas deferens. The prostate base lies inferior to the bladder and the prostate apex lies caudally continuous with the penile urethra. On the basis of its embryological origins, the prostate is anatomically divided into three zones that are eccentrically located around the urethra (the transition zone is the innermost zone, then the central zone, and the outermost peripheral zone). In elderly patients, the transition and central zones cannot be distinguished radiologically because of compression of the central zone by benign prostatic hyperplasia in the transition zone and are, therefore, together called the central gland. Seventy percent of all prostate cancers are located in the peripheral zone, whereas 20% emerge from the transition zone, and 10% in the central zone. The neurovascular bundle courses bilaterally along the posterolateral aspect of the prostate, in the five and seven o'clock positions and are a preferential pathway of tumour spread.
What are the challenges in the pharmacotherapeutic management of male genital tuberculosis?
Published in Expert Opinion on Pharmacotherapy, 2023
Aditya Prakash Sharma, Rajeev Kumar
Genital TB does not universally respond to pharmacotherapy and may require additional surgery [14]. There is limited data on the effectiveness of pharmacotherapy in managing infertility caused by genital TB [15]. The sequelae of TB in the genital organs often results from inflammation, scarring, and distortion of the anatomy and may no longer be amenable to medical therapy [16]. Surgical treatments such as vaso-vasostomy, vaso-epididymal anastomosis, and transurethral resection or incision of ejaculatory duct have been described for patients developing male infertility secondary to genital tuberculosis [6]. Structural abnormalities can also cause cosmetic deformities (Figure 1), functional obstructions, and anatomic obstructions which persist despite adequate pharmacotherapy. Scrotal and prostatic abscesses may require drainage if they do not respond to medical treatment. Cases of urethral strictures requiring urethroplasty have also been reported [17].
Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens
Published in Cancer Investigation, 2021
Serkan Akan, Caner Ediz, M. Cihan Temel, Ferhat Ates, Omer Yilmaz
Open radical retropubic prostatectomy was performed in all patients with the patient in dorsal decubitus and Trendelenburg position. After routine lower midline incision, endopelvic fascia was opened and the puboprostatic ligaments were divided. The dorsal venous complex was controlled and the urethra was exposed meticulously. We used the electrocautery minimally in these steps in order to protect the nerves and the erectile function. The prostate was dissected from the rectum posteriorly with blunt and sharp dissection. The seminal vesicles and the ejaculatory ducts were identified. The lateral prostate pedicles were ligated separately with 2/0 Vicryl sutures. The bladder neck was opened near the prostate tissue and the prostate was resected. Bladder neck was reconstructed if needed. The urethrovesical anastomosis was constructed with a Foley catheter placed and the catheter was removed on the postoperative day 14.
Value of clinical parameters and MRI with PI-RADSV2 in predicting seminal vesicle invasion of prostate cancer
Published in Scandinavian Journal of Urology, 2021
Bumjin Lim, Se Young Choi, Yoon Soo Kyung, Dalsan You, In Gab Jeong, Jun Hyuk Hong, Hanjong Ahn, Choung-Soo Kim
However, it is difficult to accurately predict SVI before pathologic analysis. The risk of SVI is usually determined according to preoperative information [21]. There have been several studies on the prediction of SVI before surgery [22,23]. Although transrectal ultrasound-guided seminal vesicle biopsy has been suggested [10,24], this method is invasive and difficult for many patients. Sometimes it is difficult to distinguish between SVI and intraprostatic ejaculatory duct invasion as the lining epithelium has the same histological appearance in core needle biopsied tissues. Moreover, the limited efficacy of seminal vesicle biopsies is due to low incidence of SVI, occasional false positives, and its low sensitivity. These methods are also recommended for high-risk groups but do not provide more accurate information than standard clinical information. Therefore, the clinical risk of SVI is currently based on clinical parameters such as the clinical stage, serum PSA levels, and GS of biopsy specimens and tools such as the Kattan nomogram, Partin tables, and Roach formula [15–17].