The prostate and seminal vesicles
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Radical prostatectomy is suitable for localised disease and should be carried out only in men with a life expectancy of >10 years. A wide excision approach can give clear surgical margins in T3a disease. Exclusion of metastases would require a negative bone scan and MRI of the pelvis. It is a procedure that should be performed only by experienced surgeons when there is a high chance of cure. It results in a high incidence of impotence, but a low incidence of severe stress incontinence (<2%), which may require the fitting of an artificial urinary sphincter or urethral sling. It involves removal of the prostate down to the distal sphincter mechanism in addition to the seminal vesicles (Figure78.24). The bladder neck is reconstituted and anastomosed to the urethra. Modifications to this operation by Walsh can lead to preservation of the neurovascular bundles that lie behind the prostate. This modification has led to the preservation of erectile function in about 60-70% of cases. Laparoscopic approaches to radical prostatectomy, often with robotic assistance, generate similar oncological results to the open approach with a more rapid recovery.
Anesthesia for Urogenital Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
The prostate gland is located at the base of the bladder, surrounding the prostatic urethra. The gland is pear-shaped and has five lobes. Only the median and lateral lobes are enlarged and surgically excised in primary idiopathic prostatic hypertrophy. In the majority of males older than 50 years of age, the submucosal glands and the smooth muscle of the prostate undergo glandular and leiomyomatous hyperplasia, a process stimulated by testicular hormones. Consequently the normal prostatic tissue is pressed against the fibrous capsule of the gland, forming a “surgical capsule,” consisting of compressed normal prostatic tissue and veins, infiltrated by nodular or new growth. Compressed prostatic veins are entered during TURP and irrigating fluid is absorbed into the intravascular compartment. Fibrosis of the hypertrophied gland can occur, reducing the vascularity of the gland. Less bleeding occurs and less fluid enters the circulation when a fibrotic gland is resected.
The urinary tract and male reproductive system
C. Simon Herrington in Muir's Textbook of Pathology, 2020
The prostate gland is positioned at the base of the bladder, and surrounds the proximal urethra. The seminal vesicles, which lie posterosuperiorly, and join the vasa deferentia from the testes, drain into the posterior prostatic urethra adjacent to a small promontory, the verumontanum, which is easily seen at cystoscopy. The seminal vesicles do not store the spermatozoa but, similar to the prostate gland, produce secretions necessary for the nurture of spermatozoa. The prostate is composed of numerous glandular acini, which drain via ducts into the urethra. One of the secretions of these glands is prostate-specific antigen (PSA), which may be detected in blood; elevated levels are found in patients with carcinoma of the prostate, but levels are also raised when the gland is either large or inflamed.
MicroRNA-143 inhibits proliferation and migration of prostate cancer cells
Published in Archives of Physiology and Biochemistry, 2022
Elshan Bajhan, Behzad Mansoori, Ali Mohammadi, Dariush Shanehbandi, Vahid Khaze Shahgoli, Elham Baghbani, Khalil Hajiasgharzadeh, Behzad Baradaran
Cancer refers to a group of diseases whose common and major characteristics include unregulated cell growth, invasion, and spread of cells from the original position to other parts of the body (Aghajani et al. 2020). Thus, this disease develops as a result of uncontrollable cell division and is influenced by environmental factors and genetic disorders as well (Pecorino 2012). Among common cancers, prostate cancer (PC) is one of the most prevalent types of malignancies in males, which has one of the poorest prognoses. In spite of considerable advances in medicine nowadays, PC is still the most prevalent cancer in men. The prostate is a small gland located just below the bladder, surrounding the upper part of the urinary tract. Various factors have a role in the development of PC, the most important being its tendency to metastasis to bone. Cancer metastasis to the bone is generally incurable and has significant complications prior to a patient’s death (Roodman 2004, Karami et al. 2013). Therefore, it is necessary to understand the mechanism of PC metastasis to help prevent metastasis and develop an anti-metastatic treatment that can reduce the complications and PC death rate.
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
Bladder and urethral function and dysfunction can be resembled to a long movie, as the whole story can be figured out, only if we consider every single event from the very beginning to the end and link them together. Based on our experience on thousands of children with bladder dysfunction, an algorithm showed in Figure 1 can describe the development of UAB. Prolonged BOO, such as chronic urinary holding in children, is likely to result in acquired striated sphincter overactivity, which in part leads to detrusor-sphincter discoordination (Figure 1). Such condition is defined as detrusor-sphincter dyssynergy in neurological disease. Subsequently, bladder neck becomes hypertrophied in order to overcome relative outflow obstruction and compensate bladder emptying. The hypertrophied bladder neck becomes increasingly less elastic and more obstructive and deteriorates the condition [137,138]. As a result, bladder neck-detrusor discoordination, and trabeculated bladder could be developed. Ultimately, if such condition persists, decompensated detrusor and UAB would be maintained which is the end stage bladder and could be called ‘bladder failure’.
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
In women with SUI where surgical intervention is being considered, it is important to ascertain the mobility of the bladder neck. The surgical literature suggests the presence or absence of bladder neck hypermobility not only to determine surgical outcome but also to determine the route of sling placement in women69. This can be done easily during a pelvic examination with a Q-tip inserted into the urethra. The angle of deflection of the Q-tip from the horizontal with Valsalva effort determines the degree of urethral mobility; a maximal angle of 30° or more is in general accepted as clinical bladder neck hypermobility70. Alternately, ultrasound can be used to assess the bladder neck position. Some clinicians even use simple visual assessment of bladder neck descent during straining or cough71.
Related Knowledge Centers
- Urinary Tract Infection
- Urination
- Urine
- Pelvic Floor
- Ureter
- Pelvis
- Urethra
- Gross Anatomy
- Kidney
- Vesical Veins