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Common Concerns with the Aging Urinary System

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WCU NUR 684 Spring 2018

Hi i’m cynthia atwell and i will be completing a short informational video on the urinary system of the aging adult we will review common aging changes and focus on benign prostatic hypertrophy in the male adult when you complete viewing this video you will be able to list three normal aging processes of the urinary system identify signs and symptoms of urinary

System dysfunction and manage the care of the patient following a trans urethral resection of the prostate as with all other systems the urinary system and the aging adult changes as well in the renal system normal aging changes alone lead to a 10% reduction of lemare your filtration rates per decade in an average healthy adult this begins about age 30 30 you say

Life’s just beginning at age 30 and we already have aging changes yeah we’ll cover that in a few minutes this change is a combination of a decrease in kidney mass the loss of properly functioning lemare ui and tubules causing a reduction of blood flow and a change in regulatory hormones such as vasopressin atrial natriuretic hormone and the rena annuitants and

Aldosterone system this combined change will affect water and electrolyte management because so we don’t all get off center of it all it starts at 30 the amazing human body usually maintains the ability to regulate fluid imbalances under normal conditions usually it’s not until a more advanced age or with disease and/or other filling systems that something needs

To be monitored more closely changes are also noted in the lower part of the system reduced bladder elasticity and nerve conduction lead to a decrease in urine flow rate a decreased and voided volume which leaves a post void residual and decreased bladder capacity the change of innervation in the urinary system leads to completely empty any of the bladder urgency

And involuntary contractions and the bladder this delay or change in signals from the bladder to void it can create many different problems in the older adult older adults are not usually able to move with the same agility as when they were younger so the possibility of an embarrassing incontinence episode or the more concerning danger of a fall it can affect

Their social needs and create a potentially dangerous injury incomplete emptying of the bladder leads to increased risk of infection which can cause confusion and again the breed increased risks for falls we have talked about common occurrences in the older adult urinary system in this next segment i would like to focus a little more closely on benign prosthetic

Approach of the er bph in our older male population vph leads to frequency urgency and hesitancy of urinary elimination this usually occurs after the age of 50 lower urinary tract symptoms such as bladder weakening and urinary tract infections bladder stones and continence and retention are common in the older population for the male these things can be complicated

By an enlarged prostate since prostate cancer in vph have the same symptoms it’s very important to obtain a prostate specific antigen test or psa to help and distinguishing between the two when you have a gentleman who was born male voicing complaints of a weak stream interment avoiding straining to avoid frequency or continually filling is if he needs to urinate

Increased nocturnal voiding and or urine c you might have a prostate problem you need to address now i specify who was born male because in our changing society it’s very important to differentiate this you can change over the external point park you want to but it will not change the internal anatomy you can add the male genital region but this new urine outlet

Will still use the original internal plumbing if we look at the normal male genital urinary system you see the bladder empties down through the prostate and out the urethra here the prostate once it starts enlarging you see here a large an enlarged one you have issues with spasms and this is what causes the decrease in the stream and you have the urinary pooling

There are different treatment options available depending on the severity of the obstruction and the symptoms if the urinary tract infection is suspected in there is urinary retention in the bladder you need to catheterize the patient and drain it and treat with antibiotics to assess for urinary retention the patient is asked to void you can usually palpate a full

Bladder and an external bladder ultrasound can be completed to measure for post void residual post void residual is considered elevated that there’s more hundred and eighty millilitres left in the urinary bladder once the immediate need is addressed if there was a need the options for long-term management include on behavioral and lifestyle modification watchful

Waiting and medication this is the least invasive and most conservative treatment options and it’s kind of your go-to medications depend on the symptoms of the bladder dysfunction and include alpha blockers such as docs is otis and tenma’s olson and terra zosyn to relax the prostate and bladder musculature anticholinergic such as oxybutynin can be used to help

Control frequency urgency and nocturia precautionary statements we need to be very careful patients who suffer from benign prostatic hypertrophy should be very cautious when taking drugs like pseudoephedrine are diphenhydramine it increases the risk of urinary retention prostate enlargement can be diagnosed and managed with through a rectal exam in surveillance

Enlargement is expected with your aging changes bph must be diagnosed through histological findings as both prostate cancer and vph present in the same way clinical findings and imaging cannot differentiate between the two surgical intervention can be required if symptoms persist despite medical management the trans re-throw resection of the prostate or the term

Is completed by an instrument directive respect to scope not a rectus cope is interred through that you made it in the anus into the urethra and a hot wire loop is used to remove the soft tissues layers of soft tissue this is preferred over an open prostatectomy because you want to try to keep down the amount of incisions you have and it just creates other issues

The patients will notice a mild mild lower abdominal pain a discomfort an urgency from having had the catheter it’s also common for them to pass blood and small blood clot something here in it for up to a week but their suit diminishes time goes on or after if they’ve gotten up and walked around and in the blood flow increases once they rest a little bit then it

Should get better you see in this picture you have your you have your enlarged prostate and they use the water guide and pull it out and it creates a better channel for the urine to escape activity restrictions include no lifting of ten pounds for three weeks following the surgery no sexual activity and no baths you do want to make sure that you nur urinate a male

Wants to make sure after they’ve had a turk done completed that they urinate when they need to don’t hold your urine in drink plenty so that there is a good urine flow continuously because you don’t want to get blood clots and cosmic direction that way urinate on urgency use a stool softener to decrease strain when you have a bm and walk daily so that you don’t

Have blood clots if you start to run a fever if you have increased swelling in your genital area if your urine the bleeding in your urine continues past one week or it doesn’t subside once you’ve gotten up and been active then you probably need to contact your provider because there could be more things going on if the blood output increases the clots large and you

Have chills or increase pain in your lower abdomen or back or you lose the ability to urinate altogether then you need to be seen immediately because there are issues going on in this short little segment we’ve covered common urinary complications for both men and women in the increased complication because of men having a prostate we’ve covered the increased risk

Of confusion or falls that come from the urgency in the nocturia the we’ve covered the fact that ph v ph needs to be diagnosed through histology that prostate cancer in bph presents the same way and we’ve also talked about oxybutynin and ter zosyn as being away a medical management for this transurethral resection of the prostate is the surgical sort of surgical

Intervention and there are many different ways that we need to manage that afterwards and that we need to educate our patients and i hope you found this is educational if you have any questions just put it in our comment section and i will answer them thank you

Transcribed from video
Common Concerns with the Aging Urinary System By Cindi Atwell