Genitourinary System

Genitourinary System
Prepared by:
Caroline V. San Diego MAN,RN
At the end of the course unit (CU),
learners will be able to:
1. Describe age-related changes that affect
urinary elimination.
2. List measures that promote urinary system
health.
3. Outline factors to consider in assessing the
urinary system.
BPH (BENIGN PROSTATIC
HYPERPLASIA (or HYPERTROPHY)
Also known as Prostatism.
Signs and Symptoms:
• Decreased Urinary stream.
• Urinary Frequency
• Urinary Urgency
• Nocturia
• Urinary Incontinence
BPH (BENIGN PROSTATIC
HYPERPLASIA (or HYPERTROPHY)
• Incomplete Bladder emptying
• Urinary Dribbling
• Feelings of urge to void but difficulty starting
urine stream
• Decreased quality of life related to symptoms
• Altered sleep patterns related to nocturia
• Diagnosis:
• Urinalysis
• postvoiding residual
• Prostate specific antigen
• urodynamic studies
• ultrasound
• cystoscopy
• Treatment:
• Medical Treatment
– Alpha blockers – relaxing the smooth muscle of
the Prostate and bladder neck.
• doxasozin (Cardura), terasozin (Hytrin BPH) and
Tamsulosin (Flomax MR)
– 5-alpha-reductase-inhibitors – shrinks the prostate
but may cause impotence.
• Finasteride (Proscar)
• Surgical Intervention
– Transurethral Resection of the Prostate – “Rotor
Rooter” Procedure.
• Nursing Care after TURP:
– Watch out for bleeding.
– Maintain Continuous Bladder Irigation (CBI)
– Assess the color of the urine, the number and size of clots,
amount of urine
PROSTATE CANCER
• Second leading cause of
cancer in males.
• Incidence increases
with age.
• Risk Factors:
• Advanced age
• Diet high in saturated
fats
• family history
• race/ethinicity
• Signs and Symptoms:
• Maybe
Asymptomatic
• Urinary Urgency
• Nocturia
• painful ejaculation
• blood in the urine or
semen.
• pain or stiffness in
the back of thighs
• Diagnosis:
• Digital rectal exam
• PSA
– Age 60-69 years old: less than 4 ng/ml
– Age 70-79 years old: 7ng/ml
– Above 10 ng/ml : diagnosis for Prostate Cancer
• Confirmatory test: Biopsy
• Treatment:
• depends on the stage of cancer growth.
• Options:
• Radical Prostatectomy
• Radiation therapy
• Surveillance
• Holistic approach
• Nursing care:
– helping families to explore the options
– Linking to community resources
– Providing education
Urinary Incontinence
• Involuntary leakage of urine
• Associated with aging, being female and sequela
to bearing children.
• Forms of Urinary Incontinence:
• Stress Incontinence
• Urge Incontinence
• Mixed Incontinence
• Overflow Incontinence
• Functional Incontinence
• Gross total Incontinence
• Prevalence:
• Affects men and women in all health care
settings.
• It is not a normal consequence of aging.
•
• Implications of UI
• Impact on Physical and Psychosocial Functioning:
– Anxiety and depression
– Social relationship
– risk factors for development of skin breakdown
• Economic Impact
• Alteration with one’s perception to self.
• Assessment:
• Categories of Urinary Incontinence according to
onset and Etiology.
1. Transient (Acute) Incontinence
• Lists of common transient cause of UI and
reversible factors “DIAPERS”
– Delirium/Dementia
– Infection agents
– Pharmaceuticals
– Endocrine disease
– Restricted mobility
– Stool impaction
2. Established (Chronic) Incontinence
• Comprises of:
– Stress Incontinence – involuntary loss of urine during
activities that increase intra-abdominal pressure.
– Urge Incontinence – strong, abrupt desire to void and
inability to inhibit leakage in time to reach a toilet.
• Stroke and multiple sclerosis, infection or ingestion of
bladder irritants (caffeine)
• Reflex Incontinence – variation of Urge Incontinence
– Mixed Incontinence – existence of symptoms of urge
and stress incontinence at the same time.
•
• COMPONENTS OF A BASIC EVALUATION FOR
URINARY INCONTINENCE
I. History
• Focused Medical, Neurologic and
genitourinary history
• Assessment of risk factors
• Review of Medications
• Detailed exploration of the symptoms of
incontinence
• II. Physical Examination
• General Examination
• Abdominal Examination
• Rectal Examination
• Pelvic Examination in women
• Genital Examination in men
III. Postvoided residual volume
IV. Urinalysis
• Goals of Treatment of UI
• Control of voiding that occurs on various levels
extending from loss of control (Incontinence)
to independent continence.
•
• Social Continence – continence cannot be
achieved but urine leakage is contained to
maintain dignity and comfort.
•
• Partial Continence – caregiver’s assistance is
helpful in achieving continence.
• Interventions/ Strategies of Care
I. Behavioral Therapy – modification of the
patient’s behavior or environment.
• First line of treatment.
– A.Managing Hydration
• Focuses on maintaining fluid balance.
• Maintaining Bowel regularity
– B.Prompted Voiding
• Monitoring
• Prompting
• Praising
– C. Bladder Training – program of education, scheduled
voiding, and reinforcement to provide patients with
the skills to improve the ability to control urgency,
decrease frequency and incontinent episodes and
prolong the interval between voiding.
– D. Pelvic Muscle Relaxation (Pelvic Muscle
Rehabilitation)
• Increases the strength, tone and control of the
pelvic floor muscles to facilitate a person’s ability
to voluntarily control the flow of urine and
suppress the urgency.
– E. Biofeedback
– F. Pelvic Floor Electrical Stimulus – application of
electric current to sacral and pudendal afferent.
II. Pharmacological Management
• Alpha Agonists Pseudoephedrine – acts at the
bladder neck, increasing urethral tone and
decreases leakage
• Duloxetine – serotonin and norepinephrine
reuptake inhibitor.
• Estrogen – to treat urogenital atrophy
• Drugs for BPH
– Alpha Antagonists (Doxazosin) – relax the urinary
sphincters.
– 5 – α reductase inhibitors (Finesteride and
dutasteride)
III.Devices and Products
• Choice of protective undergarments
• Meticulous skin care
• Indwelling urinary catheter

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