AMA 241 Male Reproductive and Gerontology

Urinary System

Removes wastes from blood and regulates fluid volume, electrolyte, blood pressure and pH balance

Urologist treats disorders; male reproductive disorders are closely related to the urinary system so males often see a urologist for these as well

Common Disorders Renal Failure -

acute or chronic condition manifested by kidney’s inability to function

Treatment is dialysis or even transplant

Disorders cont…

Calculi – stone formations; treatment is increased fluids for small stones and lithotripsy or surgery for large

Tumors – most common in bladder, can occur in kidney; treatment based on extent and type: surgery, chemotherapy, radiation or combo

Hydronephrosis – distention of renal pelvis and calyces from kidney obstruction or ureter that cause backup of urine; treatment is to correct stricture via cystoscopy, may need nephrostomy or ureterostomy

Infections – glomerulonephritis, pyelonephritis, cystitis, urethritis; treatment is antibiotics usually

Disorders…

Male Reproductive System

Contributes toward the reproductive process

Disorders often have signs and symptoms that pertain to urinary system

Referred to urologist for treatment or surgery

Common Disorders

Benign Prostatic Hyperplasia (BPH) – non-cancerous enlargement of prostate, occurs frequently in older men as prostate begins to hypertrophy

Treatment: TURP or transurethral resection of the prostate

Disorders cont… Prostate Cancer – Most common in men over 50; best detected early by

PSA test (prostate specific antigen blood test). Treated by surgery, chemo and radiation

Testicular Cancer – Most often in men 15-34; high mortality rate. Treated by surgery, chemo and radiation

Hydrocele – collection of fluid in scrotum resulting from trauma or infection. Treated by aspiration of fluid, surgery or no treatment as fluid is often reabsorbed by body naturally

Cryptorchidism – un-descended testes. Treated by surgical correction

known as orchiopexy

Inguinal Hernia – protrusion of intestines at anterior base of abdominal wall. Treated by herniorrhaphy which repositions intestine and repair of opening in abdominal wall

Infections – epididymitis orchitis, prostatitis. Likely to spread to reproductive system due to shared organs. Treated by antibiotics

Impotence – erectile dysfunction; inability to achieve or maintain an erection. Can by psychological or organic. Treated by counseling, injections, medication or penile implants

Disorders…

Diagnostic and Therapeutic Procedures

Urinalysis – most important first step; always get fresh sample

Blood tests – BUN (blood urea nitrogen), creatinine, PSA, etc…

Cystoscopy/cystourethroscopy – direct visualization of bladder and urethra with lighted instrument

Intravenous pyelogram/retrograde pyelogram – radiographic

exam of kidneys and urinary tract using contrast studies (radiopaque dye injected into bloodstream or directly into ureters). Always question patient about allergies to shellfish and contrasts!!

Ultrasound – non-invasive use of sound waves to visualize an organ

Rectal and scrotal exams – direct palpation by physician. Patient should know how to perform testicular self exam at home

Vasectomy – surgical removal of all or segment of the vas deferens used as a birth control method to prevent sperm passage from the testes

Gerontology

Aging – branch of medicine that deals with treatment is geriatrics

Memory loss in elderly if often result of disease processes and medications

Do not stereotype- myths: weakness, sick, no longer learn, boring, lonely, cannot live alone, cannot make rational decisions, etc…- stereotypes: sensory losses, erratic sleep patterns, slowness, loss of stature, memory loss

Reinforcing Medical Compliance

Always ask for complete account of all meds taken each time patient comes to office including: prescriptions, herbals, vitamins and OTC meds.

Written and verbal instructions in easy to understand terms

Use large print

Have patient repeat instructions for reinforcement

Have patient show you how to perform procedure prior to leaving the office

Give patient copy of large appointment calendar to help keep track if necessary

Reinforcing Mental HealthAdjusting to pain or illness is easier than adjust to loss of

social interaction or dependency.

Maintain open communication; always listen attentively

Listen and be supportive; help patient cope and express feelings

Help maintain patient’s positive self-image

Assist family to maintain positive support system; act as liaison for social services or resources

Prepare patient for inability to return to previous state of health; do not be discouraging or offer false hope

Direct patient and family to specific support groups

Coping with Aging

Listen to fears and concerns; respect rights to all feelings

Alcoholism can be a coping mechanism or escape; know the signs

Suicide can be an issue due to multiple losses and deep depression; know the signs and always take seriously

Long Term Care

Group Homes or Assisted Living Facilities – for those able to attend to own ADL’s (activities of daily living) but need light supervision for safety

Long-Term Care Facilities – for those who need help with most areas of personal care and moderate medical supervision

Skilled Nursing Facilities – for those who are gravely or terminally ill and need constant supervision

Expect soome patients to react to the move to these facilities with sorrow and a deep sense of loss

Elder Abuse

Not as widely publicized; you are legally and ethically responsible for reporting to physician

Typical perpetrators are family members; both active and passive neglect can occur

Abuse can be psychological, financial and/or physical

Common risk factors:- multiple illnesses that stress family- dementia- bladder or bowel incontinence- age-related sleep disturbances that affect

caretaker’s rest- dependence on caretaker for ADL

Diseases of the Elderly

Parkinson’s Disease – slow progressive neurological disorder affecting specific cells of the brain that produce dopamine (a neurotransmitter)

Symptoms: - muscle rigidity

- bradykinesia- difficulty walking- forward bending posture- laryngeal rigidity- dysphagia- facial rigidity- tremors

Diseases cont… Alzheimer’s Disease –

Dementia with cause unknown.

Has seven levels or stages.

Symptoms:- memory loss- personality changes- anger and hostility

Always respond calmly, professionally, compassionately, quietly. Never argue, don’t expect patient to remember you, always introduce yourself each time you meet

Maintaining Health

Exercise – begin only on physician’s direction; benefits cardiovascular, musculoskeletal, nervous and endocrine systems

Diet – may be difficult for elderly to maintain healthy diet. Senses of smell and taste can diminish; increase of nutritional levels and possibly adding liquid supplements can help; meals on wheels etc…

Safety – home hazards: rugs, clutter, install handrails, phone by bed, smoke alarms, call system to check on patient, Lifeline medical alert necklaces etc…

Resources