AMA 241 Male Reproductive and Gerontology

1. AMA 241 Male Reproductive and Gerontology

2. 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

3. Common Disorders Renal Failure - acute or chronic condition manifested by kidney’s inability to function Treatment is dialysis or even transplant

4. 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

5. Disorders…

6. 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

7. 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

8. 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

9. Disorders…

10. 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

12. 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

13. 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

14. 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 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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…

21. Resources