CONTENTS: Introduction Chapter I 1.1. Anatomy and physiology of the, Thesis of Nursing

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DIPLOMA

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patients

OF THE PROSTATE

CONTENTS: 2.1. Male genital organs 2.2. Glands attached to the male genital organs A. Seminal vesicle B. Prostate 1. Generalities

2. Prostatic lodge 3. Prostate relationships
3. Prostate structure 5. Prostate physiology C. Bulbourethral gland Chapter III. General care plan Care files Technical work sheets Bibliography Introduction Chapter I 1.1. Anatomy and physiology of the prostate 1.2. Vascularization and innervation of the prostate Chapter II Summary information about the anatomy and physiology of the male genital system Prostate adenoma 3. Description of the disease 3.1. Definition 3.2. Pathogenesis 3.3. Pathophysiology 3.4. Clinical manifestations 3.5. Positive diagnosis 3.6. Complications. Evolution 3.7. Treatment of prostate adenoma 3.7.1. Medical treatment 3.7.2. Hormonal treatment 3.7.3. Surgical treatment
4. Methods of approach 2. Postoperative complications of adenomectomy 3.8. The role of the nurse in preoperative preparation and postoperative care Chapter IV.

Rudimentary as a child, it begins to increase its volume with the onset of puberty. From this age, her diseases start, especially the inflammatory ones, related to the beginning of sexual life. The genesis of the adenoma, like any tumor, is unknown. knows the cause or causes of its occurrence. However, we can talk about a prophylaxis of the complications it can cause, and this is achieved through periodic monitoring of the adenoma and timely surgical treatment. The prostate is very important in men's pathology through the diseases it causes In the occurrence of the adenoma, we cannot speak of a prophylaxis, because there is none prostate adenoma, benign tumor, less often prostate cancer begin to appear. Supporting memorandum Spontaneous complications can occur in the evolution of the adenoma, such as: infection of the adenoma or adenomyitis, vascular ruptures, which cause small or more abundant hemorrhages, less often adenoma cancer. With advancing age, after 50-60 years, inflammatory lesions become rare, but can present, diseases that can cause both urinary and sexual manifestations. Prostate adenoma develops after the age of 50, less often at a younger age. It has a slow and progressive evolution. It can evolve for years absolutely silently, or causing mild disturbances, which do not attract the individual's attention.

The intrinsic relationships are with the prostatic urethra and the ejaculatory ducts. Due to the close relations of the prostate with the prostatic portion of the urethra, as a result of the size of the volume of the prostate (prostatic hypertrophy), the urethra can be blocked with the impossibility of removing urine from the bladder. The bladder ball is formed which requires emergency evacuation either by bladder probe (rubber probe) or by puncture, immediately above the pubic symphysis. and posteriorly with the retrovesical space. Between the lodge and the gland, the periprostatic space is formed, in which there is loose connective tissue. Around the gland, this condensed tissue forms the periprostatic fascia (fascia prostatae). Next to this tissue are the vesico-prostatic venous plexuses. The periprostatic fascia should not be confused with the gland's own capsule. The prostate is fixed by the perineum, by the puboprostatic ligaments and by the adhesions with the urethra and the urinary bladder.

• inferolaterally with the anal levator muscles, with the sacro-genito-pubic lamellae and with the anterior extensions of the ischiorectal fossa, superiorly, the base of the prostate (basis prostatae) is in relation to the base of the urinary bladder, the seminal vesicles and the deferent ducts; The modern and most logical attitude in case of prostate adenoma consists in performing the surgical intervention, which consists in removing the hypertrophied lobe of the prostate. This can be done with the help of an instrument called a resectoscope that is inserted into the urethra (transurethral resection of the prostate), the vas deferens are temporarily connected to prevent infection. The membranous urethra is the narrowest part of the urethra after it has entered the external urethral opening. Its narrowness is due to the contraction of the urethral sphincter. The fact that the membranous urethra is the least extensible part of the canal is also due to this circular muscular covering. Prostate reports can be systematized in two categories:
• lower, the tip of the prostate (apex prostatae) is in direct relation to the genital diaphragm on which the structure rests, the prostate is made up of glandular substance (substanta glanduris) and a cusculoconjunctival storma, in which smooth muscle fibers, specific to this gland, are predominant, having the role of evacuating the prostatic secretion during ejaculation. The glandular substance forms four lobes: two lateral lobes (dexter lobe, sinister lobe), the prostate isthmus (isthmus prostatae), which joins the two lobes The extrinsic reports of the prostate are the following: -intrinsic relationships, with the organs that cross it;
• anteriorly, with the pubic symphysis, from which it is separated by a space in which there is connective tissue and the prostatic venous plexus, delimited superiorly by the subprostatic ligaments;
• extrinsic reports, made through the walls of the prostatic chamber. The loja communicates, through the spaces between the puboprostatic ligaments, with the prevesical space,
• posteriorly, with the rectal ampulla, from which it is separated by the prostatoperitoneal aponeurosis of Demonvilliers;

Arterial irrigation is given by the lower vesical arteries (vesicalis inferior) and by lateral and located in front of the urethra, sometimes missing, the middle lobe (lobus medius), middle rectal arteries (rectalis media). located in the posterosuperior part of the gland and the posterior lobe (lobus posterius) located in the posteroinferior portion near the rectum. The veins open into the prostatic venous plexus, which surrounds the gland and then drains into the internal pubic vein. Connection between the prostatic venous plexus and the vertebral venous plexus is clinically important. The avalvular veins from the prostatic venous plexus drain into the avalvular vertebral veins. Since blood flows in both directions, it can be pushed, during a cough, sneeze or an effort, from the prostatic venous plexus into the vertebral veins. Once it reaches the vertebral venous plexus, the blood can also pass into the segmental intervertebral veins and from there into the azygos venous system. So blood from the urethra and bladder can reach the heart through the superior vena cava instead of passing through the inferior vena cava. The internal vertebral venous plexus is large enough to carry pelvic blood, if the vena cava is obstructed. The glands are of two categories: periurethral, of the mucous type, located around which they open through holes in the urethra, and the actual prostatic glands of the tubuloveolar type, in number of 30-50, whose excretory channels join to form the prostatic ducts (duct prostatic), which open in the prostatic sinuses, they are in relation to the urethral sphincter, they are extrasphincteric, unlike the periurethral ones that are intrasphincteric. The inerglandular stroma consists of smooth, collagenous and elastic muscle fibers. The prostate is wrapped in its own capsule, made of dense connective tissue, Cancer cells from a prostate tumor can metastasize in this way in the vertebral column, invading the vertebrae and generating secondary cancerous tumors (metastases). In this way, the high frequency of vertebral metastases after prostate cancer applies. elastic and smooth muscle fibers, from the level of which start musculoelastic conjunctive septa that separate the glandular parenchyma, crossed by the ejaculatory ducts and the prostatic utricle, the urethra being located anteriorly. The lymph goes to the internal, external and sacral iliac lymph nodes. The intervention is given by the prostatic plexus, a branch of the lower hypogastric plexus that contains sympathetic and parasympathetic fibers. urethra The prostate is of great medical interest, because benign nodular hyperplasia of the prostate is a common condition in elderly men. This condition starts around the age of 50 and leads to variable degrees of obstruction of the bladder colon. , The dimensions and activity of the prostate are regulated by sex hormones. The prostate is small but grows rapidly during puberty (between 13-16 years). In most men, the prostate progressively enlarges (hypertrophy), but in some it becomes more fibrous and shrinks (that is, it undergoes a process of atrophy).

1.2. Vascularization and innervation of the prostate

From the size of a chestnut and the weight of 20 grams, the prostate can grow to the size of an adult's fist and the weight of 80-100 grams or even several hundred grams. -difficulty urinating; Sometimes the patient does not show any symptoms until an acute urinary retention suddenly sets in. It is necessary for the doctor to intervene through a survey or other measures to avoid serious complications.

• the impossibility of completely emptying the bladder, the need to urinate often during the night, instead of the urine being eliminated through a continuous jet, it flows slowly, slowly even drop by drop. The signs that accompany prostate hypertrophy are: Along with the decrease in the production of sex hormones, in older men sometimes hypertrophy of the prostate appears, an increase in the volume of this organ which is located in the beginning of the urethra, surrounding it from all sides and whose structure is partially muscular and partially glandular. 1.3. Prostate hypertrophy

Testicles - have the role of producing spermatozoa and male sex hormones. Male testicles or gonads are oval in shape, 3.75 cm long and 2.5 cm thick. Each testicle consists of several seminiferous tubules wrapped around them, in which spermatozoa are produced. Their outer covering consists of a calcus made up of smooth muscle fibers, whose contractions facilitate the passage of spermatozoa to the ejaculatory ducts The spermatozoa contained in the seminal fluid are transported through seminal ducts (spermatic ducts), which have different names, according to the segment considered: The testicles are contained in a median sac, formed by concentric tunics, called the scrotum, and the urethra passes through the male copulatory organ, the penis. The penis is the copulatory organ of the man, but also the organ of urination, because it also contains the spongy part of the urethra. It is located medially above the scrotum. It has an almost cylindrical shape and consists of the root and a free part. The root, which constitutes the fixed part of the penis, is located deep in the perineum and fixed to the pelvic bones by the fundiform ligament and the suspensory ligament of the penis.

• straight seminiferous tubules; The free part consists of the body of the penis and the glans.
• the testicular network; scrotum The testicles, located outside the abdominal cavity, are protected by the scrotum, a kind of bag located behind the penis and considered to be a continuation of the cavity
• efferent ducts; The male genital organs are represented by the two genital glands -
• epididymal duct; testicles, seminal ducts, penis and scrotum.
• efferent duct; The male genital organs form a sperm transport system. They are limited to two testicles located in the scrotum, with excretory ducts (epididymis and vas deferens), secretory glands and penis.
• ejaculatory duct. The last segment, the ejaculatory duct, opens onto the seminal colliculus from the prostatic urethra, so that starting from this formation, the male urethra becomes a common conduit for the elimination of urine and sperm. THE MALE GENITAL APPARATUS Chapter II 2.1. THE MALE GENITAL ORGANS SUMMARY OF ANATOMY AND PHYSIOLOGY

Their capacity is 5-10 ml, the length is 5 cm, but if they unfolded, they would reach 10-15 cm. Taking into account that they are about 5 mm thick, the appearance of the seminal vesicles is that of a tube. In children, they are small, they develop quickly, starting with puberty. Placement - the seminal vesicles are located above the prostate, between the urinary bladder and the rectum, in the connective tissue of the pelvissubperitoneal space.

2.2. THE GLANDS ATTACHED TO THE MALE GENITAL ORGANS

• the muscular tunic, formed by superficial bundles, arranged longitudinally and deep, arranged circularly.

A. SEMINAL VESICLE

Reports. Previously, they correspond to the bottom of the bladder. Posteriorly, they answer the rectum, medially the ampullae of the vas deferens pass through them. Laterally, they have relationships with the prostatic and bladder venous pleura.

• mucous tunic - contains secretory cells, which secrete components of the seminal fluid and an enzyme (vesiculase) with coagulant effect on the seminal fluid. The base corresponds to the peritoneum, the rectovesical excavation (Douglas) and is crossed It is a paired organ. It has a secretory role, its product being added to the seminal fluid. At the same time, it has the role of a reservoir, in which the liquid secreted by the spermatic ducts accumulates. Fructose, contained in the secretion of seminal vesicles, is an important source of energy for spermatozoa. The arteries come from the lower vesical artery and the middle rectal artery. The seminal vesicles have a conical shape, with the base oriented upwards, backwards and outwards, and the tip downwards, forwards and inwards. The direction of the seminal vesicles is therefore oblique. in the urethra, before it has entered the bladder. The tip continues with an excretory duct that joins the base of the prostate with the vas deferens. Their surface is irregular, with numerous protrusions and depressions. Inside, the seminal vesicles have many diverticula (folds) that give them an alveolar appearance. The veins go to the vertical and prostatic plexuses. The lymph is drained to the internal iliac lymph nodes. Irregularities are determined by the coiling of the seminal vesicles. Structure. The walls of the seminal vesicles are made up of three tunics:
• adventitia tunic located on the surface;

The color of the prostate is grey-reddish. The consistency is elastic, but firm, easy to perceive by rectal touch. In a normal state, its surface is smooth, in certain pathological circumstances, it presents hardened portions and irregularities. Dimensions. The prostate is little developed at birth. It grows explosively at puberty and continues to grow in adults. In the elderly, the prostate can atrophy, but most of the time it hypertrophies and compresses the urethra. It measures 3 cm vertically, 4 cm transversely and 2.5 cm sagittally. An adult has a weight of 20-25 g.

• sometimes it presents a transversal protrusion, which divides it into two areas. The clinical form that the doctor finds through rectal examination is that of an ace of spades whose upper extremities - the horns - continue with the seminal vesicles, and the tip with the urethra. A median groove, easily perceived, located on the posterior face, marks the limit between the two lateral lobes of the prostate External conformation. In a newborn, it has a spherical shape. In adults, it is usually compared to a slightly flattened antero-posterior chestnut, or to a slightly recurved cone in front. The prostate is described as: The prostate is a gland located in the pelvissubperitoneal space, below the bladder The prostate is located under the urinary bladder, behind the pubic symphysis, in front of the ampulla rectal, above the urogenital diaphragm and the levator anal muscles. As these muscles separate the pelvis from the perineum, it turns out that the prostate is deep in the pelvis, in the pelvissubperitoneal space. urination, developed around the initial portion of the urethra.
• a front face; Its name comes from the Greek "prostates"= which stands before.
• a rear face; In fact, if the pelvic organs are approached anatomically or surgically -
• two inferolateral faces; The axis of the prostate is oblique, oriented from top to bottom and back to front, forming with vertical an angle of 20-25 degrees.
• a base projected upwards; on the perineal way, the first organ that "stands before the others" is the prostate. The prostate is contained in a lodge, limited by six walls: - the anterior wall - formed by the pelvic bones;
• a peak that looks down; **1. Generalities

2. Prostatic lodge B. PROSTATE**

4. Structure of the prostate

• The base - it was compared to a roof with two slopes, separated by a slight The prostate develops in the 3rd month of the embryo, and in an adult it reaches 3.8 cm in length and 20-30 g in weight at puberty. The gland is composed of 30-50 tubes or small glands, whose secretion is around 1/4 of a teaspoon per day and which pours into the urethra and the ejaculatory ducts. The tissues that surround the secretory ducts and the gland are composed of muscles with elastic fibers and collagen, which are a support and a hard shell. transverse ridge. The anterior slope corresponds to the neck of the urinary bladder, the posterior slope to the seminal vesicles and the deferent ducts. The transverse ridge corresponds to the portion of the bottom of the bladder located immediately behind the neck. The ridge is raised by the middle lobe of the prostate, which is most frequently involved in gland hypertrophy. the upper part, on the median line, has an incision, and the tip is sharp. These characteristics made the rear face to be likened to an "ace of spades". It has the following important relationships: it is partially covered by the striated sphincter of the urethra; responds to the rectal ampulla; between the rectal ampulla and the prostate there is a conjunctival formation Separating the prostate from the overlying organs by dissection, the three areas appear very clearly. In the anterior area, the internal orifice of the urethra surrounded by the fibers of the bladder sphincter can be distinguished. The middle area varies in appearance. In children and young people it is very reduced, in the elderly it can develop a lot due to the hypertrophy of the middle lobe, which raises the vertical trigone and especially the posterior lip of the internal opening of the urethra.
• fibrous, Denonviliers rectovesicoprostatic septum which easily allows the surgical separation of the two organs. The posterior relations of the prostate with the rectum are important for practical applications: they allow digital exploration (rectal cough) and surgical approach to the gland; explain rectal phenomena in prostatitis and vesicoprostatic phenomena in rectitis, hemorrhoids; explains the fluid emissions in some individuals when passing the faecal bowl. The urethra is deformed, the opening is narrowed, and urination becomes difficult. The posterior area is actually a transverse depression, through which the ejaculatory ducts enter the gland. The tip or "beak of the prostate" rests on the urogenital diaphragm, to which it adheres through the sphincter of the urethra. It is found below the line passing through the lower edge of the pubic symphysis, 2 cm from it and 3 cm from the anus.
• Inferolateral faces - they are convex and respond to the levator anal muscles, covered by their fascia. Between the levators and the prostate is the corresponding portion of the sacrorectogenitopubic blade. Lateral to the levators are the anterior extensions of the ischial fossa. This report explains the possibility of opening a prostatic or periprostatic abscess in the ischioanal fossa, after perforating the levator muscle. This is also how bladder phenomena are explained in the case of ischial phlegmons. At the union of the inferolateral faces with the base, the hilum of the gland is found, i.e. the place where its vessels enter or exit.

the base located behind the bladder neck and extends down to the plane that passes through the ejaculatory ducts. This plane is obliquely descending from top to bottom and back to front. It should be noted that the ejaculatory ducts do not actually cross the glandular substance, but insinuate themselves between the group of lateral and middle glands. There are authors who understand by "isthmus" the middle lobe. Besides the glands, we also find a musculo-conjunctival-elastic stroma, in which smooth muscle fibers predominate, a feature that is a characteristic of the organ. The posterior lobe - it is not homologated in the anatomical nomenclature, but it is recognized The internal structure of the prostate consists of 3 lobes. The inner lobe, which surrounds the urethra, is the one that causes inflammation in elderly people. It constricts the urethra producing a multitude of collective symptoms, known as ÿbenign prostatic hypertrophy (BPH)ÿ. The outer lobes or capsules of the gland are a reserve in a surgical intervention for the elimination of benign prostatic hypertrophy (BPH); is where prostate cancer occurs. The prostate secretes a milky liquid, which spills into the prostatic portion of the urethra, usually during sexual intercourse. The prostate is a storage gland, and its abundant musculature fulfills the biological role of evacuating the secretion extremely quickly during ejaculation. by clinicians due to its great importance in pathology. It occupies the postero-inferior peripheral part, far from the urethra, but adjacent to the rectum. The location of the prostate predicts future problems, which may arise due to the growth potential of the prostate, which can gradually strangle the urethra, Ontogenetic, functional and architectural - the prostate glands are grouped into four causing a multitude of possible problems. From the statistics, 11% of American men were surprised that there is a prostate and 57% do not know the symptoms of prostate disorders. lobes: two lateral lobes, connected by an isthmus, the middle lobe and the posterior lobe. We remind you that the prostate is covered on the outside by the sphincter of the urethra The lateral lobes - right and left - form the largest part of the gland. They are found and inside it the urethra is surrounded by the sphincter of the bladder. Outside the external sphincter is the prostate fascia or periprostatic capsule, originating from the visceral pelvic fascia. All these formations are not part of the prostate. on the sides and back of the urethra, below an oblique plane that passes through the ejaculatory ducts. On the posterior median line, they determine the groove open to the respective face.

The isthmus of the prostate is a thin glandular bridge, located in front of the urethra, which connects the two lateral lobes. It may contain glandular tissue, but most often it consists only of conjunctival- muscular stroma. There are rare cases when the isthmus is missing. In these cases, the urethra wrapped in the sphincter of the bladder is located in a groove on the anterior face of the prostate. The structure of the prostate is predominantly glandular. The middle lobe - forms the postero-superior part of the gland. He occupies the part of The prostate glands form the parenchyma and are arranged in several groups, separated into lobes.

6. Vascularization and innervation of the prostate

C. BULBOURETHRAL GLAND

Bulbourethral glands are also known as Cowper's glands. They there are two of them: right and left. The prostate would have a genital role. Its extirpation, (at least in animals), reduces them The arteries come from the lower bladder and the middle rectal. From these, capsular and trabecular branches come off, both of which emit arterioles that capillarize around the glands. Their volume is variable, sometimes reaching up to 1 cm in diameter. They have a whitish-white color and an elastic consistency. reproductive capacity. The veins originating from this capillary network follow a parallel path, but in reverse The bulbourethral glands are located in the angle between the bulb of the penis and the segment After the age of 20-25 years, concretions form in the prostatic alveoli arteries. They open in the prostatic venous plexus, which surrounds the gland and flows back into the internal pubic vein. membranous of the urethra and are contained in the urogenital diaphragm. The lymphatics are formed from perialveolar plexuses, reach a periprostatic plexus and from here to the external, internal and sacral iliac nodes. from concentric, sometimes calcified layers called sympexions or amylaceous bodies, which constitute the so-called "prostatic sand". They are made of proteins (sparmin crystals) and their number increases with age. The prostate is a hormone-dependent gland, being strongly influenced by sexual hormones. Present at birth, it develops "explosively" at puberty. During adulthood, the lateral lobes are stimulated by testosterone production, while the middle lobe and the periurethral glands are under the influence of estrogens. With age, under normal conditions, testosterone production decreases and the prostate atrophies. This senile atrophy affects the entire organ, both the glandular component and the musculo-conjunctival one. The nerves come from the prostatic nerve plexus, located on the posterior and lateral sides of the If, along with the decrease in testosterone secretion, there is an increase in the estrogen level, "prostate hypertrophy" will occur. This particularly interests the periurethral glands and the middle lobe. Instead, an increase in the concentration of testosterone produces prostate cancer, which includes especially the posterior lobe. gland. The prostatic nerve plexus comes from the lower hypo-gastric plexus (mixed plexus: sympathetic and parasympathetic). The nerves go along the vessels and end with sensitive, secretory and motor fibers. This is where the practical application of hormonal influence on prostate tumors can be derived: the adenoma is treated with testosterone, and the cancer with estrogens and castration

Vessels and nerves. The arteries are branches of the internal pubic artery. The veins cross the deep transverse muscle, narrow in the prostatic venous plexus. The lymph reaches the internal iliac nodes. Nerves are branches of the vagus nerve. The bulbourethral glands are embedded between the fibers of the deep transverse muscle of

• forward and medially with the membranous segment of the urethra. the perineum, which compresses it during ejaculation, causing the content to be expelled. The ratios of the bulbourethral glands are as follows: Bulbourethritis (Cowperitis) is a usually gonococcal inflammation. The infection spreads from the urethra. The outer duct of the gland is 3-4 cm long. He goes obliquely forward and inward; it passes through the lower fascia of the urogenital diaphragm, then the penile bulb and opens into the initial portion of the spongy urethra.
• down, with the lower fascia of the urogenital diaphragm and with the penile bulb; Structure. The bulbourethral glands are of the acinar type. They secrete a clear, viscous fluid, similar to the prostatic fluid, which reaches the urethra during ejaculation, where it is added to the spermatic fluid.
• up with the superior fascia of the urogenital diaphragm;