Prostate - SpeedyLook encyclopedia

Anatomy and functions

The healthy prostate is roughly of the size of a nut, from 15 to 25 G at the adulthood, very small with the birth, it is at the time of the Puberté that it takes volume. This gland will undergo one second period of growth after the 60 years age. It surrounds just the Urètre below the Vessie. It is located in front of the Rectum and a part, which one would suspect being a " not G masculin" , can be felt during a rectal examination.

The male urethra has two functions: to evacuate the Urine during the micturition and to transport sperm during ejaculation. It is inside the prostate that is made the junction between the urethra coming from the bladder, the Vas deferens and the seminal Vésicule.

Sperm is composed of the spermatozoa and the seminal fluid; approximately 10 30% of the seminal fluid are produced by the prostate, the remainder is produced by the seminal blister. The prostate also contains a muscle which helps to expel sperm during ejaculation. To function correctly, the prostate needs Androgène S (Hormone S male). The androgens are responsible for the male sexual characters. The principal androgen is the Testostérone, which is produced mainly by the Testicule S.

Exploration

Rectal examination

The examination of the prostate by a Médecin is carried out using a Examination rectal. The doctor introduces a finger, protected from a Doigtier lubricated, in the Rectum of the patient. The prostate can be palpated thus ahead. Its size is appreciated by it and a nodule can be detected. The examination is painless and without danger.

Biology

The serum concentration of the specific prostatic Antigène (PSA) is increased in the event of Cancer of the prostate but also in certain benign pathologies.

Echography

The prostatic echography uses the ultrasounds and their reflection to obtain an image. The transmitting and receiving probe lubricated is introduced into the rectum of the patient and makes it possible to visualize the prostate thus. This examination is, in general, painless and without danger. It makes it possible to visualize gland, to evaluate its volume, to seek anomalous zones (but with a poor sensitivity; about 30%).

Within the framework of cancer, echography can visualize anomalies of the wall prostate sufferer which help with stadifier the disease. Also, the large majority of the biopsies prostate sufferers are carried out by way transrectale using the echography which guides the taking away precisely. These taking away (approximately 10) have the advantage of being done under local anesthesia. It little or painful and are not very well supported.

Abdominal echography also makes it possible to visualize the Rein S, the small basins and the uretères in order to see the repercussion of the prostatic obstacle upstream. It also makes it possible to measure a possible vesical residue after micturition (or " residue post mictionnel") very frequent in hypertrophies obstructive of the prostate (adenoma).

Urodynamique

One can try to quantify the secondary obstacle with the prostatic Hypertrophie (section Adénome below) by an assessment Urodynamique, by measuring the Pression intravésicale (in the Vessie) by the introduction of small a Sonde. One can in the same way evaluate the flow and the Force of the jet of Urine.

Radiology

The Radiologie passed in the second plan since the advent of echography in the exploration of the prostate. The intravenous injection of a product iodized at the time of a UIV (Urography will intra venous) makes it possible to visualize the whole of the urinary tracts and to detect a print prostate sufferer with the collar of the bladder if the body is increased by volume. This examination is subjected to the risks of any injection of iodized products of contrast: problems of Allergy and Impaired renal function.

Imagery by magnetic resonance

IRM is an examination of choice for all explorations of the prostate, mainly for the assessment of a cancer of prostate, that it is known or occult (patients presenting a clinical or biological suspicion of cancer, but with one or more series of negative biopsy). In certain centers, one carries out even the IRM before the biopsies prostate sufferers to improve their output. One can also use the IRM to describe certain malformations (rare) interesting the prostate. Exploration by IRM is carried out using a specific antenna placed either in the Rectum of the patient (following the example echography), or around the basin (pelvic antenna). In the first case, the study of the prostate can profit from a metabolic study by spectroscopy NMR (SRMN); in the other, the study of the perfusion prostate sufferer after injection of a product of contrast or the imagery of diffusion improves its performance.

Disorders of the prostate

Adenoma of the prostate

The adenoma of the prostate is a benign tumor ; it is a anatomo-pathological entity which corresponds to the presence of Nodule S fibro-epithelial in the Stroma. It touches 80% of the men of more than 50 years and corresponds to the ageing of prostatic fabric. This condition is known like benign Hypertrophie of the prostate (or Hyperplasie benign of the prostate ) and can be treated with drugs or thanks to the surgery (ablation of part of the prostate). This type of surgery nowadays is usually carried out with a long instrument introduced by the urethra, the resector, which make it possible to introduce an electric current (monopolar or bipolar), or a fiber " laser" who minimizes the bleeding, without having recourse to an external incision.