NR 601 Week 6 TD 2 (NR601)

Exam (elaborations) NR 601 Week 6 TD 2 (NR601) Men and women both can experience urologic concerns with aging. This week's presentations and readings covered urologic concerns and common problems. Utilize the national guidelines and scholarly references to develop your responses. Urinary Incontinence Men and women can both get UTIs. What factors contribute to the development of a UTI in men versus women? Include risk factors. Men= BPH, kidney stone, urinary retention, self catheterization, cauterization in the hospital, Women= anatomy, poor hygiene, In which sex is a UIT more concerning and why? Men are more concerning BPH As a provider it is essential for you to know to interpret DRE findings and what your next step should be. The American Urology Association has specific recommendations based on age. Be sure you know these because the guidelines will guide your patient counseling and treatment plan.  What does the AUA state about drawing PSA levels? 4K score  If you do decide to draw a level what specific counseling should you include in your education today? Anal sex and ejaculation  Urinary tract infections  It is important to know when to treat a UTI and when not to treat. Is there a particular situation where you would not treat a UTI? Urinary Incontinence What factors contribute to the development of a UTI in men versus women? Cystitis, which is the most commonly seen lower urinary tract infect (UTI), and pyelonephritis, the most commonly seen upper UTI (Uphold & Virginia Graham, 2013). For women, the main cause of a UTI is usually related to bacteria that enter the urethra (Uphold & Virginia Graham, 2013). The urethra is shorter in women than compared to men plus it is closer to the perirectal area, making women more prone to infections (Uphold & Virginia Graham, 2013). Other risk factors for women include using tampons, if they’re postmenopausal, increased sexual activity, and pregnancy (Uphold & Virginia Graham, 2013). For men, it is uncommon for them to develop cystitis and pyelonephritis because their urethra is longer but it does happen (Uphold & Virginia Graham, 2013). In younger men, it is believed that a UTI can occur because of subclinical prostatitis or endogenous bacteria without an underlying cause (Uphold & Virginia Graham, 2013). In older men (over 50), UTI’s are generally related to structure abnormalities such as BPH, obstruction such as kidney stones or urethral strictures, or retention issues such as with a neurogenic bladder (Uphold & Virginia Graham, 2013). Other risk factors include lack of circumcision, rectal intercourse, HIV infections with low CD4 and T-lymphocyte counts, and intercourse with a female who has vaginal colonization of uropathogens (Uphold & Virginia Graham, 2013). In which sex is a UTI more concerning and why? In general, men are more concerning when it comes to UTIs because their symptoms are generally nonspecific and therefore can go left untreated (Brusch, 2017). BPH What does the AUA state about drawing PSA levels? to be screened and men between 40 to 54 years old do not need to be screened unless they have a strong family history of prostate cancer or they are African American (AUA, 2015). For men who are between 55 to 69 years old, the AUA suggests screening based on the man’s preference and values; it suggests having the patient weigh the benefits against the cons before proceeding (AUA, 2015). For this age group, if a PSA is desired, screening regimens can be tailored based on the baseline PSA results (AUA, 2015). Lastly, the AUA does not recommend screening men who are over 70 years of age, unless they are in excellent health, or who they feel will not live greater than 10 to 15 years (AUA, 2015). If you do decide to draw a level what specific counseling should you include in your education today? It is important to let the patient know that an elevated PSA does not always mean cancer. PSA is a glycoprotein that can be produced by malignant and benign (Goroll & Mulley, 2014). It is also important to let the patient know that certain activities or situations can increase the PSA as well, these include urinary retention, trauma to the area, rectal intercourse, UTI and prostatic infections, post ejaculation for 1 to 2 days after, BPH, and post cystoscopy (Goroll & Mulley, 2014). According to Goroll & Mulley (2014), distinguishing between BPH and prostate cancer can be difficult and will require a biopsy. It is important to know when to treat a UTI and when not to treat. Is there a particular situation where you would not treat a UTI? A UTI should not be treated if the patient is asymptomatic, specifically they have no complaints of dysuria, urgency, frequency, fever, flank pain, abdominal pain, or tachycardia and as long as the urinalysis with culture does not show more than 100,000 CSUs (Brusch, 2017, Uphold & Virginia Graham, 2013). References American Urological Association (AUA) (2015). Early detection of prostate cancer. Retrieved from