The prostate Fig 262

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In health the prostate is approximately the size of a walnut. It surrounds the prostatic urethra and lies between the bladder neck and the urogenital diaphragm. The apex of the prostate rests on the external urethral sphincter of the bladder. It is related anteriorly to the pubic symphysis but separated from it by extraperitoneal fat in the retropubic space (cave of Retzius). Posteriorly, the prostate is separated from the rectum by the fascia of Denonvilliers.

• Structure: the prostate comprises anterior, posterior, middle and lateral lobes. On rectal examination a posterior median groove can be palpated between the lateral lobes. The prostatic lobes contain numerous glands producing an alkaline secretion which is added to the seminal fluid at ejaculation. The prostatic glands open into the prostatic sinus. The ejaculatory ducts, which drain both the seminal vesicles and the vas, enter the upper part of the prostate and then the prostatic urethra at the verumontanum.

• Blood supply: is from the inferior vesical artery (branch of the internal iliac artery, p. 57). A prostatic plexus of veins is situated between the prostatic capsule and the outer fibrous sheath. The plexus receives the dorsal vein of the penis and drains into the internal iliac veins.

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