0:00

Let's focus on prostate anatomy

0:03

from proximal to distal.

0:07

This is, these are terms that are used to

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describe the base of the prostate,

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which is going to be up higher, and the apex of

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the prostate, which is going to be down lower.

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We're going to divide from top to

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bottom the prostate into, into thirds.

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So we got, we have an upper third,

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which is going to be the base.

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We're going to have a middle third,

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which is going to be the mid.

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Okay.

0:29

And we're going to have a distal third,

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which is going to be the apical portion of the gland.

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You'll also hear the gland

0:36

divided up from medial to lateral.

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Now, we've already given you some designations

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for the zones and some abbreviations for such.

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But, uh, some people will actually divide the

0:48

gland into a more mesial intermediate portion of

0:52

the gland and a less mesial intermediate portion.

0:56

Lateral portion of the gland.

0:58

And it's actually described as

1:01

intermediate mesial and lateral lateral.

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So you'll hear that designation floating around.

1:08

I personally will just call it, uh, medial

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versus lateral, which is pretty simple.

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And I will use the abbreviations that you

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learned in the Axial Anatomic Vignette.

1:20

Okay, so let's take this all

1:21

off the screen for a minute.

1:23

And now let's look at the video.

1:25

The gland appearance as we go from base to apex.

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Now this might be a little bit confusing, but it's

1:32

actually not as challenging as you might think.

1:35

So let's start with our axial pancake of

1:38

a prostate gland here in the upper third.

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So in the front of the gland, we've got the left

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and right AS, or anterior fibromuscular stroma.

1:53

Then we've got the transitional zone behind that.

1:57

Let's make the transitional

1:59

zone a little more posterior.

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And we're going to have a

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TZA and a TZP on each side.

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So you can divide that in half.

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And you're going to have the

2:09

urethra and the periurethral tissue.

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We'll make that, uh, gray.

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Kind of smack dab in the middle there.

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And we'll even draw in the

2:17

periurethral tissue just for giggles.

2:19

Here's some periurethral tissue.

2:21

Right here.

2:23

And then behind that, we're going to

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have in blue, the, the central zone.

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And it kind of, kind of

2:32

looks a little bit lobular.

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And the central zone and TZ

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make up the central gland.

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And they will progressively enlarge

2:40

as you get a little bit older.

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And then everything else around

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the outside is going to be the PZ.

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So we're going to have right PZA, PZP,

2:50

PZM in the back, and left the same thing.

2:53

So that's your, that's your base appearance.

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Now let's go to the mid level of the

2:58

gland, and I'm going to draw that again,

3:02

but I'm going to keep my other diagram up

3:04

intentionally so you can make a comparison.

3:08

And now it's, it's virtually identical,

3:10

except that the, the anterior fibromuscular

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stroma tends to coalesce more as sort of one.

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As you go down a little bit, they kind

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of bleed into each other, so you can't

3:25

really distinguish so easily a separation.

3:28

Between right and left.

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Now, the TZ, which we've got in, in orange, is

3:35

going to kind of take over here at this level.

3:39

We don't have a CZ, because the CZ is only

3:43

up in the upper part of the gland,

3:45

the central zone, part of the central gland.

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And then everything else is peripheral zone.

3:51

We're going to have PZA, PZP,

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and PZM on the right and left.

3:55

Alright, now we've got to go to

3:57

the apical portion of the gland.

4:01

Get our green color out again.

4:03

The gland's getting smaller

4:05

because you're going down.

4:06

That's no secret or surprise.

4:09

And now the transitional zone is also

4:12

going to be a little bit smaller.

4:13

But you're still going to have a

4:15

smaller TZA and TZP, which are front

4:21

and back bisected right in the middle.

4:24

You're still going to have a

4:25

urethra with periurethral tissue.

4:28

I didn't bother to put it over here.

4:30

I probably should have.

4:31

Here's your urethra again.

4:33

We've got some periurethral tissue around it.

4:37

And you'll be able to separate those

4:38

out by their signal intensity on MRI.

4:43

And then everything else

4:44

down low is going to be PZ.

4:47

So there's no central zone down here.

4:50

And the anterior fibromuscular stroma.

4:53

Is once again going to bleed together

4:55

in a kind of a short stubby little

4:57

flat structure here anteriorly.

5:01

Then we go down one more cut down at this level.

5:04

We're out of the prostate gland

5:07

and we're simply and purely in the urethra

5:11

with the periurethral tissues around it.

5:16

And then we run into the external

5:17

sphincter in your genital diaphragm.

5:20

And we have a sphincter up higher.

5:23

At the level of the bladder.

5:24

So those are the three basic

5:26

levels you're going to see.

5:27

Base, mid, and apex.

5:30

And then you'll have a medial and a lateral or an

5:32

intermediate and a lateral component to the gland.

5:36

So let's move on to the sagittal

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if you have time to watch with us.

5:39

Shall we?