0:00

Let's talk about the sector map and anatomy of the gland,

0:03

and I'm gonna show you the coronal and the lateral

0:07

or sagittal projection.

0:08

Remember, the sagittal projection is often used

0:11

for the height and the AP dimension when you're using the

0:14

ellipsoid method of measuring prostate volume.

0:17

The transverse dimension is gonna be in the axial

0:19

projection, and then we've got the coronal projection,

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which can be a little bit confusing,

0:25

but I use the coronal projection a lot to see

0:28

where I am in the axial projection.

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You know, whether I'm at the base, the mid gland,

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or the apex of the gland.

0:34

You can also use the sagittal for that purpose as well.

0:37

Now there are a couple of confusing areas

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and points on the anatomy.

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Let's start out with this sagittal

0:43

or lateral sector diagram.

0:46

First, we have done away with the term a central gland.

0:50

You know, we have a central zone,

0:53

and that's this green area that that wraps

0:55

around the ejaculatory duct.

0:57

You can find it when it's enlarged in the postero superior

1:01

quadrant of the gland projecting up into the bladder base,

1:05

and it can be really nasty in terms of trying to urinate

1:09

for people that have this enlargement.

1:11

Then a little trick in the peripheral zone,

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which is here in pink,

1:15

most people forget the peripheral zone wraps around

1:20

the bottom of the central zone and comes around front

1:23

and intersects with this blue area,

1:26

the anterior fibromuscular zone.

1:28

So this anterior portion is often overlooked.

1:31

Now in the coronal projection,

1:33

especially when you're anterior, most people forget

1:37

that the peripheral zone takes a more coddle position

1:42

and they may misconstrue this area as either

1:45

fibromuscular tissue or zone or transitional zone tissue.

1:50

The transitional zone is pretty easy.

1:52

It's found in the center of the gland.

1:55

Remember, we, we don't use the term central gland anymore,

1:58

but it's found in the middle of the gland, so to speak,

2:01

and it wraps around the urethra.

2:03

Now, sometimes nodules from the TZ

2:07

or transitional zone may extrude into the peripheral zone

2:11

like this, and they made diffusion restrict.

2:14

You've gotta look very carefully

2:16

because you will see a communication

2:19

with the transitional zone as opposed to a cancer,

2:22

which is gonna be out here

2:24

and has no communication whatsoever

2:27

with the transitional zone.

2:29

Another potential problem, not a pitfall,

2:31

but a problem is if you have a transitional zone nodule

2:35

that encroaches on the urethra.

2:37

This is a type of BPH

2:39

or benign prostatic hyperplasia that is very heinous

2:43

because it produces some severe urinary symptoms.

2:47

And then another point I'd like

2:49

to bring forth on this lateral sagittal diagram

2:53

is you can actually subcategorize BPH,

2:56

you can decide if the

2:58

Anterior portion of the gland is big.

3:01

This would be a type one,

3:02

or the posterior portion of the gland is big

3:06

and pushes the urethra forward.

3:09

That would be a type two, or they're balanced.

3:12

In other words, this portion

3:13

of the gland is equally hypertrophy to this portion

3:16

of the gland and the urethra doesn't move.

3:18

And then finally you have nodules projecting into the

3:21

urethra, and that would be a type four.

3:23

So you have the anterior form type one,

3:26

the posterior form type two, the balanced form type three,

3:31

and the nodular urethral form type four.

3:36

Let's move on, shall we?