AMA 241 Male Reproductive and Gerontology

AMA 241 Male Reproductive
and Gerontology
Urinary System
Removes wastes from
blood and regulates
fluid volume,
electrolyte, blood
pressure and pH
Urologist treats
disorders; male
reproductive disorders
are closely related to
the urinary system so
males often see a
urologist for these as
Common Disorders
Renal Failure
- acute or
manifested by
inability to
Treatment is
dialysis or even
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
Male Reproductive System
Contributes toward
the reproductive
Disorders often
have signs and
symptoms that
pertain to urinary
Referred to
urologist for
treatment or
Common Disorders
Benign Prostatic
Hyperplasia (BPH) –
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
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
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
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 Health
Adjusting 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
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
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
- 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
- muscle rigidity
- bradykinesia
- difficulty walking
- forward bending posture
- laryngeal rigidity
- dysphagia
- facial rigidity
- tremors
Diseases cont…
Alzheimer’s Disease –
Dementia with cause
Has seven levels or stages.
- memory loss
- personality changes
- anger and hostility
Always respond calmly,
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