PROSTATE GLAND
P
PROSTATECTOMY: REMOVAL OF THE PROSTATE GLAND
Two of the possible methods of removal are shown. The
transurethral method (TURP) is the most commonly used.
It avoids the disadvantages of an abdominal incision and
usually permits a shorter stay in hospital. The retropubic
method may be necessary if the prostate is very enlarged
or if surgery is a treatment for prostate cancer.
TRANSURETHRAL PROSTATECTOMY
Bladder
Capsule
Prostate gland
Bladder
Cutting edge
2
A heated wire loop, or sometimes a cutting
edge, is inserted through the resectoscope
and used to cut away as much of the prostatic
tissue as possible.
Tissue
washed out
Electrode
cauterizes
bleeding
vessels
3
The pieces oftissue are washed out
through the resectoscope and any
bleeding vessels are cauterized by means
of an electrode passed up the tube.
RETROPUBIC PROSTATECTOMY
Site of
incision
1
Under general anaesthesia, an incision
is made in the abdomen to expose the
bladder and prostate. The surgeon cuts
open the capsule containing the gland.
2
The surgeon then removes the prostatic
tissue. Once it is removed, bleeding
vessels are cauterized and a catheter is then
passed up the urethra in order to drain urine
from the bladder.
4
The resectoscope
is then withdrawn
and a catheter passed
via the urethra into the
bladder. The catheter
drains urine from the
bladder and allows
blood to be washed
out. It can usually
be removed within
24 hours.
3
A tube is inserted beside the empty
capsule to drain any fluid and blood that
may collect; the abdomen is sewn up. The tube
and catheter are left in for a few days.
p ro sta te g la n d
A
s o l i d ,
c h e s t n u t - s h a p e d
o r g a n
t h a t
s u r r o u n d s t h e f i r s t p a r t o f t h e m a l e
u r e -
th ra .
T h e p r o s t a t e g l a n d i s s i t u a t e d j u s t
u n d e r n e a t h
t h e
b la d d e r.
I t
p r o d u c e s
s e c r e t i o n s t h a t f o r m p a r t o f t h e s e m i n a l
f l u i d d u r i n g
e ja c u la t io n .
T h e
p r o s t a t e
g l a n d
c o n s i s t s
o f t w o
d i s t i n c t
z o n e s : a n
i n n e r
z o n e ,
w h i c h
p r o d u c e s s e c r e t i o n s t h a t k e e p t h e l i n -
i n g o f t h e u r e t h r a m
o i s t , a n d a n o u t e r
z o n e ,
w
h i c h
p r o d u c e s
s e m i n a l s e c r e -
t i o n s . T w o e j a c u l a t o r y d u c t s p a s s f r o m
t h e
s e m i n a l
v e s i c l e s
t h r o u g h
t h e
p r o s t a t e g l a n d t o e n t e r t h e u r e t h r a ; t h e
d u c t s
c a r r y
f l u i d
a n d
n u t r i e n t s
f r o m
t h e v e s i c l e s t o b e a d d e d t o t h e s e m
e n .
T h e p r o s t a t e g l a n d w e i g h s o n l y a f e w
g r a m s
a t
b i r t h .
A t
p u b e r t y ,
a n d ro g e n
h o rm o n e s
c a u s e
t h e
g l a n d
t o
e n l a r g e ,
a n d i t r e a c h e s a d u l t s i z e a t a r o u n d a g e
2 0 .
I n m
o s t m
e n ,
t h e p r o s t a t e b e g i n s
t o e n l a r g e f u r t h e r a f t e r t h e a g e o f 5 0 .
T h e r e a r e a n u m b e r o f d i s o r d e r s t h a t
a f f e c t t h e p r o s t a t e g l a n d . T h e s e i n c l u d e
b e n i g n p r o s t a t i c h y p e r t r o p h y ( s e e
p r o -
s ta t ic h y p e rtro p h y , b e n ig n ) ,
c a n c e r
( s e e
p ro sta te , c a n c e r o f ),
a n d
p ro s ta t it is
( i n -
f l a m m a t i o n o f t h e p r o s t a t e g l a n d ) .
p ro s ta te -s p e c ific a n tig e n (P SA )
A n
e n z y m e
t h a t i s n o r m a l l y p r o d u c e d b y
t h e p r o s t a t e g l a n d . I f t h e e n z y m e i s p r o -
d u c e d
i n
e x c e s s ,
i t
m a y
i n d i c a t e
t h e
p r e s e n c e
o f
p ro s ta t e c a n c e r;
t e s t s
t o
d e t e c t b l o o d l e v e l s o f P S A a r e t h e r e f o r e
u s e d a s a s c r e e n i n g t e s t f o r p r o s t a t e c a n -
c e r .
H o w e v e r ,
P S A l e v e l s
m a y
a l s o
b e
r a i s e d
i n
o t h e r
c o n d i t i o n s
s u c h
a s
632
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