"Chronic Prostatitis": part 3

Anatomy and Physiology

by Ivo Tarfusser, MD

To enable us to understand the possible mechanisms leading to "chronicprostatitis" we have to know some basic facts about the anatomy andphysiology of the prostate.

The prostate is a gland situated underneath the bladder(the bladder neck) and is perforated by the first portion ofthe urethra. The 2 ejaculatory ducts enter the upper part ofthe prostate from behind, travel through the gland and open into the urethra ona small protuberance (3-4 mm) of the urethral mucosa called theverumontanum ("veru").
The veru isvery critical because of the convergence of several other structures:

Other important anatomical structures, mostly neglected in the literature,are the seminal vesicles (SV).Theseglands reside on the backside of the lower part of the bladder, their body(about 5-8 cm long, .6-1 cm wide) lies alongside the deferent duct (whichcarries the sperm cells from the testis to the urethra) and empties into thisduct before the deferent duct enters the prostate to become the ejaculatoryduct. The SVs are structurally hollow organs comparable to the gallbladder, butwith multiple small saccular compartments (looking almost like a grape)interconnected with each-other. The wall of the SVs is composed of an internalcellular lining (glandular cells) which produces a fluid necessary for theextracorporeal survival of the sperm cells. This fluid, together with the fluidfrom the prostatic acini, constitutes a major part of the volume of thespermatic fluid; only a small part comes from the testicles. The outsidemuscular shell of the SVs contracts and expells the secretion at orgasm.

In summary, in a minute spot of the prostatic urethra around the veru,covering an area not larger then 1 square cm (about 1/6 square inch) we find allthe openings where the spermatic secretion has to pass through. One can immaginethat a slight change (focal inflammation with edema, calcifications, microscarsafter inflammatory disease etc) can distort, compress, obstruct (partially orcompletely, temporarily or definitively) those tiny openings creating all theconditions necessary for disease in one, few or many prostatic glandularsubunits or the seminal tract. Of course, if passage through one or several ofthese ducts is not completely restored (e g due to inadequate treatment of anacute exacerbation of prostatitis, permanent changes like calcified deposits ofdetritus or scars) we'll have to expect chronification of the inflammatoryprocess (not always symptomatic) with acutisation from time to time. The closerelationship of the SVs and the prostate to the bladder neck and the trigone (anarea in the bladder floor adjacent to the bladder neck), the most sensitiveparts of the bladder with a dense concentration of sensory nerve endings,explain the occurrence of urgent desire to void frequently associated withirritative conditions in the prostate/SV. In conclusion, an comprehensiveappreciation of the anatomical structures and their relationship is necessaryfor the understanding of the different syndromes that run under the term of "chonicprostatitis", instead of a view limited to the prostate only.

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    Ivo Tarfusser, MD
    Corso Libertà 63
    39012 Merano (BZ), Italy
    Tel (+39) - 335 - 24 16 86, (+39) - 473-237319
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