2. TOP TEN REASONS WHY MEN PUT OFF
DOCTOR VISITS
• "I don’t have a doctor."
• Step one toward staying healthy is finding a doctor you
trust. But you’ll never know if you trust one unless you try.
Check your insurance company or local listings for doctors in
your area. Call their offices and ask questions, or check
around online. It’s also a good idea to check with friends and
family for recommended doctors.
• "I don’t have insurance".
• "There’s probably nothing wrong."
• "I don’t have time."
• "I don’t want to spend the money."
2
3. WHY MEN DON’T GO TO THE DOCTOR
• "Doctors don’t DO anything.“
• "I don’t want to hear what I might be told.“
• "I’ve got probe-a-phobia.“
• "I’d rather tough it out.“
• "My significant other has been nagging me to get a
checkup."
4. SUSCEPTIBILITY OF THE URINARY
SYSTEM
• Urinary tract is made up of a continuous mucosal lining
that gives organisms entering the urethra a direct
pathway through the system
• In females, the urethra is located in close proximity to
anus and vagina
• This exposes the renal system to microorganisms that
can cause infection
4
5. SIGNS AND SYMPTOMS
• Wide range of symptoms occur with disorders of the
renal system
• Changes in frequency of urination
• Dysuria, urgency, retention, incontinence
5
6. COMMON DIAGNOSTIC TESTS
OF THE URINARY SYSTEM
• Kidney-ureter-bladder (KUB) x-ray
• Renal scanning
• Cystography and voiding
• Intravenous pyelography (IVP); may be called
intravenous urography (IUG)
• Arteriography (angiography)
• Renal computed tomography (CT)
• Renal ultrasonography
• Cystoscopy
• Retrograde pyelography
6
7. DISORDERS OF THE URINARY SYSTEM
• Urinary incontinence
• Urinary tract infections and inflammations
• Urethritis
• Cystitis
• Pyelonephritis
• Treatment of urinary tract infections
• Antibiotics
• Glomerulonephritis
7
11. CYSTOSCOPY AND EXTRACORPOREAL
SHOCK WAVE LITHOTRIPSY
11
(From Leonard P: Building a medical vocabulary: with Spanish translations, ed
7, St Louis, 2009, Saunders.)
14. NEOPLASMS OF THE URINARY TRACT
14
(From Damjanov I: Pathology for the health related professions, ed 4, St Louis, 2010, Saunders.)
15. RENAL FAILURE AND ITS TREATMENT
• Sudden, severe onset
• Acute or chronic
• Three stages
• Treatment: dialysis
• Hemodialysis: uses artificial kidney machine to filter waste
products from blood and return to body
• Peritoneal dialysis: uses capillaries in peritoneal cavity to filter
blood by infusing abdomen with dialyzing fluid through implanted
catheter
15
16. DIALYSIS
16
(From Ignatavicius D: Medical-surgical nursing: patient-centered collaborative care, single volume, ed 6, St Louis, Saunders.)
21. ANATOMY AND PHYSIOLOGY OF THE
MALE REPRODUCTIVE SYSTEM
• Male sex cells vital for creation of life
• Testes are primary reproductive organs
• Sperm cells
• Penis
• Organ of male copulation
• Has elongated body and large end
• Hormone production
• Primary hormone is testosterone
21
22. MALE REPRODUCTIVE ANATOMY
22
(From Frazier MS, Drzymkowski JA: Essentials of human diseases and conditions, ed 5, St Louis, 2013, Saunders.)
24. PROSTATE DISORDERS
• Diseases of the prostate
• Prostatitis
• Develops in the presence of infection
• Benign prostatic hyperplasia
• Cells grow rapidly, enlarge organ
• Prostate cancer
• Usually asymptomatic in beginning stages
24
26. PATHOLOGIC CONDITIONS OF
THE GENITAL ORGANS
• Epididymitis
• Balanitis
• Hydrocele
• Testicular cancer
• Erectile dysfunction
• Infertility
26
27. SELF-EXAMINATION FOR
TESTICULAR CANCER
• Most common cancer in Caucasian men
15 to 34 years of age
• Men should perform a 3-minute self-exam, starting at
age 15
• Instruct the patient on how to perform the exam using a
model, if available
27
31. SEXUALLY TRANSMITTED INFECTIONS
• Bacterial STIs
• Chlamydia
• Gonorrhea
• Syphilis
• Viral STIs
• Hepatitis B, C, D
• Genital herpes and genital warts
• HIV
31
32. THE MEDICAL ASSISTANT'S ROLE
IN EXAMINATIONS
• Assisting with a urologic examination
• No special setup for routine exam
• Assisting with a male reproductive examination
• Understand the system and offer support throughout exam
• Vasectomy
• Surgically sterilize male patient
32
33. VASECTOMY
33
(From Chabner DE: The language of medicine, ed 7, Philadelphia, 2004, Saunders.)
https://youtu.be/MOaL93xoHRk
34.
35. CLOSING COMMENTS
• Patient education
• Attitude has an effect on life span
• Legal and ethical issues
• Ensure informed consent is given for all procedures
• HIPAA applications
35
Editor's Notes
Describe the male urethra. (The male urethra is about 8 inches [20 cm] long and is divided into
three sections: the prostatic urethra [which passes through the prostate gland at the base of
the bladder], the membranous urethra, and the penile urethra.)
Abnormal functions of any part of the urinary tract often can be determined through
urinalysis, blood urea nitrogen (BUN) levels, and analysis of creatinine clearance.
For more detail on these diagnostic tests, refer students to Table 40-1 (p. 819).
Urinary incontinence, which is a temporary or chronic loss of urinary control, can be the result
of many conditions, including urinary tract infections, brain disorders, and tissue damage.
Cystitis symptoms include very mild to acute discomfort in the lower abdomen, urinary
frequency, and painful urination (dysuria).
Urethritis is typically caused by chlamydia or gonorrhea.
Pyelonephritis is caused by bacteria that ascend from the lower urinary tract and is
associated with conditions, such as urinary retention or obstruction, that promote urinary
stasis and the growth of bacteria.
Acute glomerulonephritis usually develops in children and adolescents about 2 weeks
after a streptococcal infection, such as strep throat or scarlet fever.
Renal calculi, or kidney stones, are created when crystals in the urine collect in the kidney,
or when fluid intake is low, creating a highly concentrated filtrate.
No indications of polycystic kidneys occur in children, but as time goes on, normal renal
tissue in both kidneys is replaced by multiple, benign, fluid-filled cysts.
Bladder cancer is characterized by one or more tumors that can metastasize through the
blood or surrounding pelvic lymph nodes.
Renal carcinoma is asymptomatic, which gives the tumor the opportunity to metastasize
to the lungs, liver, male urogenital system, bone, or brain before it is diagnosed.
Wilms’ tumor is also known as nephroblastoma and is found in children.
Figure 40-6 shows cysts on the surface of enlarged kidneys and also larger, internal cysts.
Figure 40-7 shows neoplasms of the urinary tract.
Acute renal failure has a sudden, severe onset caused by exposure to toxic chemicals,
circulatory collapse from serious burns or heart disease, acute bilateral kidney infection or
inflammation, occlusion of the renal arteries, or complications from surgery.
Chronic renal failure is a slowly progressive process caused by gradual destruction of
the kidneys' ability to filter waste materials.
What are the three stages of chronic renal failure? (The first stage involves higher than
normal creatinine levels, the second stage involves hypertension and increased BUN and
creatinine levels, and in the third stage, kidneys can't remove waste and toxicity develops.)
Figure 40-8 shows a patient on dialysis.
Figure 40-9 shows peritoneal dialysis.
In primary enuresis, bladder control was never established. In secondary enuresis, in which loss of
bladder control occurs in a child who has been consistently dry for at least 6 months, can develop
because of stressful events, UTIs, diabetes, or sexual abuse.
Reflux may be caused by faulty formation of or damage to the valves, or it may be associated
with cystitis, neurogenic bladder, or bladder overfilling because of an obstruction.
If an infant is born with an undescended testicle, the testicle usually drops without treatment
by 9 months of age.
Figure 40-10 shows a voiding cystourethrogram.
Figure 40-11 shows cryptorchidism.
The testis is an oval structure about 13∕5 to 2 inches (4 to 5 cm) long and 1 to 11∕5 inches
(2.5 to 3 cm) in diameter.
Sperm cells are tadpole-like structures less than 0.1 mm long that are carried to the
epididymis for maturation.
Around the glans penis is a fold of skin that begins just behind the glans and extends
forward to cover it like a sheath, called a foreskin.
The penis carries both urine and semen through the urethra and outside the body,
and must enlarge and stiffen to transmit semen to a female tract.
Testosterone stimulates enlargement of the testes, growth of body hair, thickening
of the skin and bones, increased muscle growth, and maturation of sperm cells.
Figure 40-12 shows the male reproductive anatomy.
Figure 40-13 shows sperm.
Infection or inflammation of the prostate gland puts pressure on the urethra, causing dysuria,
tenderness, and secretion of pus from the tip of the penis.
Enlargement of the prostate gland partly blocks the flow of urine, creating a medium for
bacterial infection that can lead to cystitis and can be treated with alpha-adrenergic blockers.
In prostate cancer, once symptoms develop, they include urinary obstruction with difficulty
urinating, frequent UTIs and nocturia (the need to void at night), hematuria, and generalized
pain in the pelvic region.
Reference the box on p. 828 for information about prostate-specific antigen (PSA) studies.
Figure 40-14 shows benign prostatic hyperplasia and carcinoma of the prostate.
Epididymitis is most often is attributed to a UTI in men over age 40; in younger men,
the most common cause is a sexually transmitted infection.
Inflammation of the glans penis and the mucous membrane beneath it is known as balanitis.
If the canal does not close after birth, fluid from the peritoneal cavity may pass through
and collect in the scrotum; this is called a congenital hydrocele.
The inability to achieve and maintain an erection sufficient for sexual intercourse is a
condition known as erectile dysfunction, which has both psychological and physiologic causes.
About 10% to 20% of male infertility cases have no known cause.
What symptoms are present with testicular cancer? (The patient complains of a mass in
either testicle; a heavy sensation in the scrotum accompanied by a sudden collection of fluid;
pain in a testicle or in the scrotum, abdomen, or groin; and unexplained fatigue. Testicular
cancer can be treated successfully if diagnosed early; the survival rate for stage I testicular
cancer is approximately 95%.)
Procedure 40-1 on p. 830 describes how to teach testicular self-examination.
Figure 40-16 shows a testicular self-examination shower card.
Reference Table 40-2 (p. 832) to see sexually transmitted diseases in men.
Gonorrhea and chlamydia organisms tend to coexist, so a patient who has tested
positive for one of the organisms typically is treated for both.
A syphilitic lesion, called a chancre, develops on the male genitalia, usually the penis,
a few days to a few weeks after exposure.
HIV invades CD4 T lymphocytes, destroying their ability to fight infection on the cellular level.
Reference the box on pp. 833-834 to see trends in reportable sexually transmitted infections.
Figure 40-17 shows a syphilitic chancre.
Much of the diagnosis of urinary dysfunction depends on the patient's history,
which may include frequency or urgency of urination, dysuria, or incontinence.
Collect specimens during office visits for immediate examination.
No special instrument setup is required for a routine urologic examination
unless a special procedure is ordered, such as obtaining a catheterized urine
specimen or a specimen for culture.
For a male reproductive exam, a male assistant is present unless the
physician requests a female.
Vasectomy is performed by surgically removing a section of each vas
deferens to stop sperm from reaching the prostate and mixing with semen.
Figure 40-18 shows how a vasectomy is done.
The solution to maintaining good health is preventive care, and the first step is establishing
a good rapport with a physician of choice. People should also have all necessary check-ups.
If the patient refuses a procedure, the assistant must have the patient sign the appropriate
informed refusal forms, which are then included in the medical record.
The Health Insurance Portability and Accountability Act (HIPAA) provides minimum
requirements for protecting personal health information, but state laws can override HIPAA
regulations if the state law is considered more stringent.
Individual healthcare institutions (hospitals, universities, physicians' practices) may have their
own policies and procedures for managing confidential information about HIV and AIDS.
