Basic anatomy and physiology of the prostate - some questions

While the web has lots of information about bph lots of it is simply
copying from other sites or repeating platitudes and dumbing down
complex functions. Some of the following may be dumb too but perhaps
one of the long term posters has some useful web links or further
information.

I read the various posts (about 500 posts ago) about the prostatic
urethra not being a tube but a duct. I wasn't around at the time but
it seemed to me that this was a distinction without a difference. OTOH
the various methods of TURP (using the word in the generic sense) seem
to work so I must be wrong. How though?

Take your index and middle fingers. Scarify or abrade adjacent parts
of the fingers. You've now got a bloody mess. Ignore the pain. Don't
put anything on the wounds; instead tape the fingers together tightly.
Keep them taped together for a month or so. Hope you don't get an
infection and ignore the smell. At the unveiling you'll find that
you've grown webbed fingers. The skin will grow back with no
distinction between the two fingers. They'll be joined together. If I
understand correctly this is because there is no dividing object (the
skin) and the cells of the underlying tissue on both fingers are the
same.

You see where I'm going here...

So presuming that there's no "skin" (i.e. tube) lining the urethra
wouldn't it simply grow together naturally? Maybe the urine takes the
path of least resistance and simply works it way around the cells of
the prostate?

This is nonsense of course. Every web illustration and every anatomy
book I have shows the urethra as a tube and in fact there's
tantalizing comments about two types of cells: the stroma and another
(endothelial or epithelial?). The stroma is the bulk of the prostate
and the other is the lining of the tube or duct. But that causes
another problem: If the purpose of TURP is to remove tissue
(presumably stroma) won't it cut and destroy the lining of the
urethra? Refer to my finger analogy above for what will happen if this
occurs.

Another tantalizing piece of information is that TURP (generic)
vaporizes or coagulates the tissue. It doesn't say that it creates
scar tissue which would be one way of stopping the sides of the now
de-linered urethra joining together. Whoa! Vaporized? You know what
happens when water vaporizes in the shower. It condenses on a nearby
object. Where does the vaporized prostatic tissue go? Coagulate I just
can't envisage. Liquids coagulate forming solids but the walls of the
urethra are already solid...?

By whatever magical method TURP (generic) cuts out the tissue we still
have a problem. There are lots of ducts feeding into the urethra. Most
of them are tiny providing prostatic fluid as part of the ejaculate (I
presume these are something like the ducts in the female nipple) but
there are two relative biggies: the ejaculatory ducts which join the
prostatic urethra at a point called the "Veru". While big they're not
that big. A tiny piece of scar tissue could easily block both ducts.
In any event any TURP procedure just lops off some section of the
ducts. Doesn't anyone see a problem with this? Something like a stent
would simply obstruct the ejaculatory process altogether. Is this
discussed anywhere or is there something about this that everyone
except me knows?

Remember that comment above about two types of cells? Well, it appears
that there are also two types of hyperplasia (as in bph): one that
concerns the uncontrolled (is it really uncontrolled?) growth of the
stroma which can be shrunk with the DHT blockers and another which is
a growth of the endothelial or epithelial cells (the liner cells). It
sounds like these are like polyps in the colon which I presume are
like skin tags. They can only be removed surgically. Whoa again! If
we've got skin tags growing in the urethra couldn't they be blocking
the ejaculatory ducts anyway?

And why wouldn't the ejaculatory ducts be subject to the same problems
as the urethra: the strangulation by the growth of the stroma and the
polyps from the lining cells? I think I have a partial answer here.
The ejaculatory ducts can be blocked by growths within them (which are
called cysts) but the strangulation by the growing stroma doesn't
occur because the ejaculatory ducts are covered by a muscle sheath at
least up to "shortly" before the veru (no definition of "shortly"
supplied). Depending on how much shortly is doesn't a TURP run the
risk of cutting into the muscle sheath?

Apparently the prostate can't grow outwards because it's enclosed in a
capsule (is this the same as the "surgical capsule"?). This seems very
strange. What other organs are enclosed in capsules? Has anyone ever
thought of removing (or slashing) the capsule to allow outward growth
and avoid the whole problem? Also why is "trans urethral" resection
the way to go (other than open prostactectomy). What's wrong with
laprascopic surgery to suck out some of that excess stroma? Sort of
like liposuction for the prostate.

I'm confused!

.

Relevant Pages