PROSTATE DISORDERS
PROSTATITIS
PREPARED BY
Ali Faleh
Baqir Sabah
Haider Shia’a
Hussain Naji
UNDER SUPERVISION OF
McS: Basam Mahdi
Introduction
• Problems affecting male genitals and urinary
system are generally difficult areas for both the
patient and the nurse to deal with because of the
sexual nature of the male anatomy
• It is important to realize that sexuality is a natural
part of each of us as human beings and should not
be avoided when we provide care to patients
• The prostate gland sits at the base of the
bladder and wraps around the upper part of the
male urethra like a doughnut
• The primary purpose of the prostate is to
provide alkaline secretions to semen and to aid
in ejaculation
• The prostate does not contain any hormones;
however, men fear that prostate problems and
treatment will cause problems with their
erections or their “nature” (sexual activities)
Prostate gland and Related organs
Urinary Bladder
Sacrum
Symphysis Pubis
Rectum
Seminal Vesicle
Glans Penis
Ejaculatory Duct
PROSTATE GLAND
Urethra Epididymis
Testes
Description of the Prostate Gland
The prostate gland lies in the pelvic cavity just
below the neck of the bladder in front of the
rectum and behind the symphysis pubis,
surrounding the first part of the urethra.
It consists of an outer fibrous covering, a layer
of smooth muscle and glandular substance
composed of columnar epithelial cells.
• The gland secretes a thin, milky fluid that
makes up about 30% of semen, and gives it its
milky appearance.
• It contains a clotting enzyme, which thickens
the semen in the vagina, increasing the
likelihood of semen being retained close to the
cervix.
• During ejaculation, muscles in the prostate
gland contract adding their contents to the fluid
passing through the genital duct.
Prostatitis
Pathophysiology
• Prostatitis- inflammation of the prostate gland,
can occur any time after puberty
• R/F- recurrent urinary tract infections,
epididymitis, BPH, urethritis, prostatic carcinoma,
DM, immunocompromised status, urethral
strictures and bladder neck hypertrophy
• Problem may be chronic or a single acute episode.
The inflammation causes the prostate gland to
swell, resulting in pain, especially when standing
Pathophysiology of prostatitis cont’d
• It may eventually lead to difficulty in passing urine
as a result of an inward squeezing of the urethra
that causes a mild obstruction
Etiology
• There are three basic types of prostatitis:
• Acute bacterial,
• Chronic bacterial, and
• Nonbacterial- An important theory about non
bacterial prostatitis includes the increased content
of creatinine, urate and white blood cells due
to reflux into the prostatic ducts. These agents can
act as chemical agents leading to an inflammatory
response
• Bacterial prostatitis is most common in older
men
• It results in oedema and inflammation of all or
part of the prostate gland
• The bacteria primarily responsible for the
infection are gram-negative organisms such as
Escherichia coli; however, gram-positive and
gonococcal bacteria may also play a part
The prostate gland may become infected by the
following:
•Bacteria ascending the urethra. Ascending
infection from the urethra and the chemical
damage secondary to the reflux of urine through
the prostatic and ejaculatory ducts
•Infected urine refluxing from the bladder into the
prostatic ducts
•Bacteria in the blood or lymph supply to the
glands
•Surgical instrumentation or other forms of
urethral trauma
Signs and Symptoms
The most common symptoms are the same as
with UTI:
• Complaints of urgency, frequency, hesitancy
and dysuria
Due to the location and role of the prostate gland,
the patient may complain of:
• Low back, perineal and post-ejaculation pain;
• May also complain of fever and chills
Diagnostic Tests
• The first test performed is digital rectal
examination (DRE) of the prostate
• The prostate gland is examined by a health-care
provider by insertion of a gloved finger into the
rectum
• The examiner may find a warm, irregular,
swollen, painful prostate gland
• A urine culture generally is positive for bacteria
• The examiner may also gently massage the
prostate gland and order an expressed prostate
secretion (EPS)
• Test can reveals bacteria and a large number of
white blood cells
• Acute bacterial prostatitis is usually treated
medically with antibiotic therapy
Therapeutic Interventions
• The preferred treatment is trimethoprim and
sulfamethoxazole (Bactrim) for 30 days
Other antibiotics, include:
• Fluoroquinolones (ciprofloxacin, ofloxacin),
may be used for chronic prostatitis
• Other forms of treatment may include anti-
inflammatory agents
• Stool softeners, warm sitz baths, prostatic
massage
• Diet changes such as decreasing spicy foods
and alcohol
• In some cases, prostate surgery is necessary to
remove the obstruction
Nursing Process for the Patient with
Prostatitis
ASSESSMENT/DATA COLLECTION
•Begin the assessment by asking patient to describe
signs and symptoms that indicate evidence of a UTI,
such as sudden fever, chills, complaints of urgency,
frequency, hesitancy, dysuria and nocturia
•In addition, the patient may have complaints of
pain in the lower back, in the perineum, or after
ejaculating
• Ask the patient if he has ever had a UTI or
prostate infection in the past
• Care must be taken to assess urinary retention
resulting from obstruction
• Obtain a urine culture and assist with collection
of the EPS specimen, if requested, as part of the
patient assessment
Possible Nursing Diagnosis
• Impaired urinary elimination related to
obstruction
• Ineffective health maintenance: knowledge
deficit related to cause, treatment, and
prevention of prostatitis
• Impaired comfort related to swelling and
irritation of the prostate gland
• Anxiety related to sexual concerns
PATIENT EDUCATION
Teach patient the causes, prevention and
treatment e.g
• Risk factors such as the use of indwelling
urinary catheters, poor hygiene or risky sexual
practices
• Excessive intake of bladder irritants such as
alcohol
• Ignoring signs of UTIs and poor compliance
with the antibiotic treatment plan
• Encourage the patient to wash his hands and
sitz bath equipment before and after each
treatment
• Fluids such as water and cranberry juice should
be encouraged up to 2500 to 3000 mL per day
unless contraindicated
• Bladder irritants in the form of caffeine
products (e.g., coffee, tea, cola, and chocolate),
citrus juices and alcohol should be taken in
very limited amounts
• Encourage the patient to empty his bladder
every 2 to 3hours even if he does not feel the
urge to urinate
Complications
• Acute prostatitis can lead to urinary retention
• If the prostate is extremely swollen, it prevents
complete bladder emptying
• Most troublesome complication may be a
temporary problem with erections
• Ascending infections, prostatic abscess,
epididymitis and prostatic calculi (stones)
Prevention
Ways to prevent prostatitis are:
• Regular and complete emptying of the bladder
to prevent urinary tract infection (UTI)
• Avoiding excess alcohol (more than 2 to 3 oz
per day—alcohol is a bladder irritant)
• Avoiding certain high-risk sexual practices
• Avoiding contamination of the urinary tract