Week 6: Urologic Concerns in the Maturing and Older Adult Discussion
22 unread replies.22 replies.
Students will not receive credit for any discussions posted after Sunday 11:59pm MT.
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 Tract Infections
What risk factors contribute to the development of a UTI in men versus women?
In which sex is a UTI more concerning and why?
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?
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?
If you do decide to draw a level what specific counseling should you include in your education
today?
Hi Class and Dr. Schroetter ( 10/8/2018 initial post)
Urinary tract infections (UTIs) are among the most common infections in people and would
require antibiotics. UTIs occur when bacteria enter the urinary tract and can affect multiple parts
of the urinary systems, but the most common UTI is a bladder infection. Reoccurring UTIs can
result in an infection that reaches the kidneys, causing pyelonephritis, but this is not common
(Center for Disease Control, 2015).
Females are at higher risk for UTIs compared to males. Females are at higher risk
because their urethra is shorter and anatomically is closer to the anus. This allows bacteria to
enter the urinary tract easier (CDC, 2015). Risk factors include having a previous UTI, sexual
activity, changes in vaginal flora, pregnancy, age, urinary incontinence, kidney stones, and
prostate enlargement. Sometimes younger children may have structural problems with their
urinary tract, and they are not adequately wiping. They may wipe from back to front instead of
wiping from front to back.
Common symptoms for UTIs are pain or burning when urinating, frequent urination,
fevers, cloudy or foul-smelling urine, cramping, and pressure. Diagnosing requires asking about
symptoms, a physical exam, and specific urine tests. Patients can be educated on methods to
prevent UTIs, such as urinating before sexual activity, keeping hydrated, showering instead of
bathing, and proper wiping from front to back (CDC, 2015).
The American Urological Association (AUA) notes that PSA levels can help for early detection
of an active disease, which will allow for initial treatment and more conservative management
through active surveillance and through watching and waiting (AUA, 2015). The goal with the
AUA guidelines is early detection of prostate cancer and reducing prostate cancer mortality.
According to the AUA guidelines, PSA screening in men under the age of 40 does not help detect
prostate cancer. It is recommended to screen for prostate cancer between the ages of 40 and 54,
as this age group is at higher risk (AUA, 2015). To reduce the risk of harm when screening early
on for prostate cancer, it is recommended to screen using two-year intervals as opposed to annual
This study source was downloaded by 100000852681095 from CourseHero.com on 01-30-2023 01:22:11 GMT -06:00
https://www.coursehero.com/file/34267641/week-6-q2-question-docx/
, screening. Lastly, it is not recommended to screen those who are over 70 with a life expectancy
of less than 10 to 15 years.
When drawing a PSA level patient should be educated on possible risks, harms, and benefits of
any results of the test. The patient should be informed about potential consequences of testing,
like the possible limited accuracy of screening and diagnostic tests, and also the possibility of
benefits and harms of screening and treatment (Hoffman, 2011). Other educational information
that should be provided is that there are inconsistencies with regards to whether PSA screening
reduces mortality from prostate cancer.
I do not believe that there would be a specific reason not to treat a UTI. I know it
becomes more challenging to treat UTIs when resistance against antibiotics occurs. Resistance
can even spread among bacteria, allowing the bacteria to fend off antibiotics which at one point
they’d never been exposed to. It is not uncommon that a patient is prescribed two, three, or even
four antibiotics to kill the UTI. For those who have to continue to get UITs fourth-line
medications are usually “broad-spectrum” antibiotics which wipe out the good bacteria in the
stomach that aid in the digestion of food and help with the body’s immune system. If UTIs are
not treated, they can lead to a kidney infection or could cause serious or permanent damage.
Women who are pregnant must use caution when prescribed antibiotics for a UTI. Pregnant
women have limited choices when treating their UTI because the antibiotic can hurt the unborn
baby. This would be the only situation why I would think someone might not treat a UTI, but
generally, UTIs need to be treated to prevent further or more severe damage.
References
American Urological Association. (2015). Early detection of prostate cancer. Retrieved from
https://www.auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-reviewed-
and-validity-confirmed-2015)
Center for Disease Control. (2015). Urinary tract infection | community | antibiotic use | CDC.
Retrieved from https://www.cdc.gov/antibiotic-use/community/for-patients/common-
illnesses/uti.html
Hoffman, R. M. (2011). Screening for prostate cancer. The New England Journal of Medicine,
7(365), 1-7. doi:10.1056/NEJMcp1103642
My professor’s response on 10/9/2018
Nice work with the Urologic Concerns discussion! You did a good job reviewing the gender differences
of UTI risk factors and "pros / cons" of PSA testing. The process of "shared decision making" within
primary care involving PSA testing is necessary, but time consuming. Vickers, Edwards, Cooperberg, &
Mushlin (2014) outlined a straight forward method to discussing the PSA test. Here's a link to the
article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412472/ (Links to an external site.)Links to an
external site.
One situation that I thought of (where you wouldn't want to treat a UTI) is asymptomatic bacturia. I see
this commonly with elderly women. They have bacteria that is colonized within their bladder, but they
aren't having any signs/symptoms of a UTI.
For the purposes of discussion... if you have a patient with BPH, what medication (prescription and
over-the-counter) would have potential to aggravate / exacerbate his symptoms?
Looking forward to your next post,
Dr. Schroetter
References
Vickers, A., Edwards, K., Cooperberg, M., & Mushlin, A. (2014). A simple schema for informed decision-
making about prostate cancer screening. Annals of Internal Medicine, 161(6), 441-
442. doi: 10.7326/M14-0151 (Links to an external site.)Links to an external site.
This study source was downloaded by 100000852681095 from CourseHero.com on 01-30-2023 01:22:11 GMT -06:00
https://www.coursehero.com/file/34267641/week-6-q2-question-docx/
22 unread replies.22 replies.
Students will not receive credit for any discussions posted after Sunday 11:59pm MT.
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 Tract Infections
What risk factors contribute to the development of a UTI in men versus women?
In which sex is a UTI more concerning and why?
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?
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?
If you do decide to draw a level what specific counseling should you include in your education
today?
Hi Class and Dr. Schroetter ( 10/8/2018 initial post)
Urinary tract infections (UTIs) are among the most common infections in people and would
require antibiotics. UTIs occur when bacteria enter the urinary tract and can affect multiple parts
of the urinary systems, but the most common UTI is a bladder infection. Reoccurring UTIs can
result in an infection that reaches the kidneys, causing pyelonephritis, but this is not common
(Center for Disease Control, 2015).
Females are at higher risk for UTIs compared to males. Females are at higher risk
because their urethra is shorter and anatomically is closer to the anus. This allows bacteria to
enter the urinary tract easier (CDC, 2015). Risk factors include having a previous UTI, sexual
activity, changes in vaginal flora, pregnancy, age, urinary incontinence, kidney stones, and
prostate enlargement. Sometimes younger children may have structural problems with their
urinary tract, and they are not adequately wiping. They may wipe from back to front instead of
wiping from front to back.
Common symptoms for UTIs are pain or burning when urinating, frequent urination,
fevers, cloudy or foul-smelling urine, cramping, and pressure. Diagnosing requires asking about
symptoms, a physical exam, and specific urine tests. Patients can be educated on methods to
prevent UTIs, such as urinating before sexual activity, keeping hydrated, showering instead of
bathing, and proper wiping from front to back (CDC, 2015).
The American Urological Association (AUA) notes that PSA levels can help for early detection
of an active disease, which will allow for initial treatment and more conservative management
through active surveillance and through watching and waiting (AUA, 2015). The goal with the
AUA guidelines is early detection of prostate cancer and reducing prostate cancer mortality.
According to the AUA guidelines, PSA screening in men under the age of 40 does not help detect
prostate cancer. It is recommended to screen for prostate cancer between the ages of 40 and 54,
as this age group is at higher risk (AUA, 2015). To reduce the risk of harm when screening early
on for prostate cancer, it is recommended to screen using two-year intervals as opposed to annual
This study source was downloaded by 100000852681095 from CourseHero.com on 01-30-2023 01:22:11 GMT -06:00
https://www.coursehero.com/file/34267641/week-6-q2-question-docx/
, screening. Lastly, it is not recommended to screen those who are over 70 with a life expectancy
of less than 10 to 15 years.
When drawing a PSA level patient should be educated on possible risks, harms, and benefits of
any results of the test. The patient should be informed about potential consequences of testing,
like the possible limited accuracy of screening and diagnostic tests, and also the possibility of
benefits and harms of screening and treatment (Hoffman, 2011). Other educational information
that should be provided is that there are inconsistencies with regards to whether PSA screening
reduces mortality from prostate cancer.
I do not believe that there would be a specific reason not to treat a UTI. I know it
becomes more challenging to treat UTIs when resistance against antibiotics occurs. Resistance
can even spread among bacteria, allowing the bacteria to fend off antibiotics which at one point
they’d never been exposed to. It is not uncommon that a patient is prescribed two, three, or even
four antibiotics to kill the UTI. For those who have to continue to get UITs fourth-line
medications are usually “broad-spectrum” antibiotics which wipe out the good bacteria in the
stomach that aid in the digestion of food and help with the body’s immune system. If UTIs are
not treated, they can lead to a kidney infection or could cause serious or permanent damage.
Women who are pregnant must use caution when prescribed antibiotics for a UTI. Pregnant
women have limited choices when treating their UTI because the antibiotic can hurt the unborn
baby. This would be the only situation why I would think someone might not treat a UTI, but
generally, UTIs need to be treated to prevent further or more severe damage.
References
American Urological Association. (2015). Early detection of prostate cancer. Retrieved from
https://www.auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-reviewed-
and-validity-confirmed-2015)
Center for Disease Control. (2015). Urinary tract infection | community | antibiotic use | CDC.
Retrieved from https://www.cdc.gov/antibiotic-use/community/for-patients/common-
illnesses/uti.html
Hoffman, R. M. (2011). Screening for prostate cancer. The New England Journal of Medicine,
7(365), 1-7. doi:10.1056/NEJMcp1103642
My professor’s response on 10/9/2018
Nice work with the Urologic Concerns discussion! You did a good job reviewing the gender differences
of UTI risk factors and "pros / cons" of PSA testing. The process of "shared decision making" within
primary care involving PSA testing is necessary, but time consuming. Vickers, Edwards, Cooperberg, &
Mushlin (2014) outlined a straight forward method to discussing the PSA test. Here's a link to the
article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412472/ (Links to an external site.)Links to an
external site.
One situation that I thought of (where you wouldn't want to treat a UTI) is asymptomatic bacturia. I see
this commonly with elderly women. They have bacteria that is colonized within their bladder, but they
aren't having any signs/symptoms of a UTI.
For the purposes of discussion... if you have a patient with BPH, what medication (prescription and
over-the-counter) would have potential to aggravate / exacerbate his symptoms?
Looking forward to your next post,
Dr. Schroetter
References
Vickers, A., Edwards, K., Cooperberg, M., & Mushlin, A. (2014). A simple schema for informed decision-
making about prostate cancer screening. Annals of Internal Medicine, 161(6), 441-
442. doi: 10.7326/M14-0151 (Links to an external site.)Links to an external site.
This study source was downloaded by 100000852681095 from CourseHero.com on 01-30-2023 01:22:11 GMT -06:00
https://www.coursehero.com/file/34267641/week-6-q2-question-docx/
