Genitourinary System PDF

GENITOURINARY SYSTEM  TOPICS: Benign prostatic hypertrophy (BPH) Bladder cancer Acute glomerulonephritis Kidney cancer Kidney stones Prostate cancer Pyelonephritis Renal failure Testicular cancer Urinary tr...

GENITOURINARY SYSTEM  TOPICS: Benign prostatic hypertrophy (BPH) Bladder cancer Acute glomerulonephritis Kidney cancer Kidney stones Prostate cancer Pyelonephritis Renal failure Testicular cancer Urinary tract infection  GENITOURINARY SYSTEM The genitourinary system refers to the parts of the body involved in the production and transport of urine, as well as the surrounding structures. The kidneys are found in the posterior part of the upper abdominal area, relatively protected by the lower ribs. They are lateral to the spinal column. The left kidney is found higher than the right kidney due to the location of the liver within the abdomen. The renal artery supplies blood to the kidneys. The nephron is the functional unit of the kidney, the area where urine is formed. Within the nephron, there is a long tubule. This initially surrounds the glomerulus in an area called Bowman’s capsule. Bowman’s capsule narrows into a proximal convoluted tubule which has many curves and eventually straightens into a downward loop of Henle, which makes a sharp turn to come back up into the cortex of the kidney.  GENITOURINARY SYSTEM The initial upward portion of the loop of Henle is thin and then becomes thick, which is the distal convoluted tubule. The kidneys are responsible for filtering wastes from the bloodstream; they aid in the control of fluid and electrolyte balance, acid-base balance, blood pressure control through production of renin, and red blood cell through the production of erythropoetin. As urine is produced within the kidneys, it travels through the ducts (ureters) to the bladder. Once the body senses the urge to empty the bladder, the detrusor muscles contract and the sphincter at the bladder neck relaxes to aid in emptying the urine. The urine passes through the urethra to the outside. Male patients have a prostate gland located under the bladder, surrounding the urethra. Prostatic fluid is secreted from the gland into the urethra. 1. BENIGN PROSTATIC HYPERTROPHY (BPH)  BENIGN PROSTATIC HYPERTROPHY (BPH) The prostate gland is found just below the bladder in men, surrounding the urethra. As men age, the prostate enlarges, putting pressure on the surrounding structures causing symptoms such as frequent urination urinary retention. The enlargement of the prostate causes narrowing of the urethra upward pressure on the lower border of the bladder. Urinary retention may develop, as the body has a harder time emptying the bladder. Hydronephrosis and dilation of the renal pelvis and ureter are complications of the urinary retention due to overgrowth of the prostate.  PROGNOSIS The symptoms of BPH are the same as those for prostate cancer. It is important for the patients to have regular check-ups to evaluate for risk of prostate cancer and conduct periodic screenings for prostate cancer. Renal function may be temporarily effected by hydronephrosis secondary to urinary retention.  SIGNS AND SYMPTOMS Urinary hesitancy difficulty initiating stream of urine due to pressure on urethra and bladder neck Urinary frequency need to urinate frequently due to pressure on bladder Urinary urgency need to get to bathroom quickly to urinate due to pressure on bladder Nocturia need to get up at night to urinate due to pressure on bladder Decrease in force of urinary stream Intermittent stream of urination Hematuria  TEST RESULTS Urography shows high volume of post-void residual urine. PSA(prostate-specific antigen) may be mildly elevated. Prostate ultrasound shows hypertrophy. Digital rectal exam reveals fullness of prostate and loss of median sulcus (midline groove between the two lateral lobes of the prostate). Urinalysis may show microscopic hematuria. BUN and creatinine levels may elevate, if renal function is impaired.  TREATMENT Administer alpha1-blockers for symptom relief: doxazosin tamsulosin terazosin Monitor blood pressure; hypotension may be side effect of some alpha1 blockers. Administer finasteride (improve urinary symptoms). to relieve symptoms by shrinking prostate gland. Monitor PSA levels periodically. Monitor renal function. Surgical removal of prostate tissue to relieve pressure. Continuous bladder irrigation postoperatively. Administer antispasmodics for patients experiencing bladder spasms.  NURSING DIAGNOSIS Risk for impaired urinary elimination Urinary retention Risk for urge urinary incontinence NURSING INTERVENTIONS Maintain the 3-port catheter postop. One port is for irrigation, another is for drainage, the third to inflate a balloon that holds the catheter in position. Monitor intake and output. Monitor vital signs for changes. Monitor postoperative patient’s bladder irrigation: Monitor the amount of fluid instilled and the amount of fluid returned and subtract the amount of fluid instilled from the amount returned to deter mine the actual urine output.  NURSING INTERVENTIONS Document color of urinary output postoperatively; the greatest risk of hemorrhage is the first day after the operation. Monitor for bladder spasms which may indicate blocked catheter drainage postoperatively. Teach patient: Avoid caffeine, alcohol, decongestants, anticholinergics which may increase symptoms of BPH. Proper home care of urinary catheter. Monitor for signs of urinary tract infection. 2. BLADDER CANCER  BLADDER CANCER Bladder cancer is typically a nonaggressive cancer that occurs in the transitional cell layer of the bladder. It is recurrent in nature. Less frequently, bladder cancer is found invading deeper layers of the bladder tissue. In these cases the cancer tends to be more aggressive. Exposure to industrial chemicals (paints, textiles), history of cyclophosphamide use, smoking increase the risks for bladder cancer.  PROGNOSIS The more aggressive the cancer cell type, the greater the risk of metastasis of the disease. Patients may have advanced disease at the time of diagnosis. The more advanced the disease at the time of diagnosis the more aggressive the tumor, the greater the risk of death for the patient.  SIGNS AND SYMPTOMS Fatigue due to chronic process Hematuria blood in urine, may be microscopic Change in urinary pattern color, frequency, amount of urine  TEST RESULTS Urinalysis shows red blood cells in urine. Cystoscopy to identify tumor site and obtain biopsy. Bladder biopsy shows cancer cell type. CT scan shows metastasis or invasion of tumor.  TREATMENT Surgical removal of tumor: May be removal of superficial tumor from bladder wall with transurethral approach; removal of part or all of the bladder. If all of the bladder is removed, a stoma is created on the surface of the abdomen or an ileal reservoir is created internally to collect the urine. Instillation of BCG (bacilli Calmette-Guérin) into bladder to decrease chance of recurrence. Radiation therapy. Chemotherapy.  NURSING DIAGNOSIS Risk of impaired urinary elimination Fear Disturbed body image Powerlessness NURSING INTERVENTIONS Monitor vital signs. Monitor skin Monitor intake and output: for signs of breakdown, redness. Document amount and color of drainage from Monitor for side effects of medications. all drains. Teach patient: Monitor color of urine. Proper skin care postoperatively. Monitor stoma for color, Catheterization of ileal reservoir if needed. checking adequate blood flow to tissue. Monitor abdomen for bowel sounds, pain, distention. 3. ACUTE GLOMERULONEPHRITIS  ACUTE GLOMERULONEPHRITIS (AGN) Glomerulonephritis, also known as acute nephritic syndrome, is typically preceded by an ascending infection or occurs secondary to another systemic disorder. Infectious causes include group A beta-hemolytic Streptococcus, measles, mumps, cytomegalovirus, varicella, coxsackievirus, pneumonia due to mycoplasma, chlamydia psittaci, pneumococcal infection. Systemic disorders include systemic lupus erythematosus, viral hepatitis B or C, thrombotic thrombocytopenia purpura, multiple myeloma.  PROGNOSIS Depending on the cause, the acute episode may completely resolve. Patients should be monitored during the occurrence; signs of renal function need to be checked. SIGNS AND SYMPTOMS Hematuria Peripheral edema Elevated blood pressure, compared with patient’s norm Oliguria decrease in urine output Nausea, vomiting, loss of appetite as renal function declines  TEST RESULTS Urinalysis shows red blood cells and red blood cell casts. Glomerular filtration rate will be decreased. 24-hour urine collection for protein will be elevated. BUN level will be increased. Serum albumin will be decreased. Renal biopsy to determine cause.  TREATMENT Monitor renal function. Monitor electrolyte levels. Monitor vital signs. Administer diuretics to remove excess fluids. Monitor urinary output. Restrict fluid intake measure output, intake should match 24-hour output plus 500 cc. Plasmapheresis if due to autoimmune cause. Plasmapheresis is a process in which the liquid part of the blood, or plasma, is separated from the blood cells. Typically, the plasma is replaced with another solution such as saline or albumin, or the plasma is treated and then returned to your body.  NURSING DIAGNOSIS Impaired urinary elimination Excess fluid volume NURSING INTERVENTIONS Monitor vital signs. Assess cardiovascular status, Monitor intake and output. heart rate, Weigh daily. heart sounds, Assess respiratory system for presence of S3 lung sounds, suggesting fluid overload. difficulty breathing, Assess extremities for edema. crackles in lungs Teach patient about medications, suggesting fluid overload. disease process. 4. KIDNEY CANCER  KIDNEY CANCER Kidney cancer occurs when cancer cells create a tumor within the kidney. Exposure to chemicals, lead, smoking all increase the risk of developing kidney cancer. PROGNOSIS Identification of renal cancer is integral to a favorable outcome. Patients often have vague symptoms and may not seek healthcare until later in the disease when the cancer is well developed. Metastatic disease has the worst prognosis.  SIGNS AND SYMPTOMS Weight loss Anemia due to altered erythropoetin production Hematuria Elevated blood pressure due to increase in renin production Flank pain, dull or aching, occurs in small amount of patients  TEST RESULTS CBC may show either anemia or erythrocytosis. Urinalysis shows red blood cells. Erythrocyte sedimentation rate elevated. Ultrasound shows renal mass. CT scan with contrast shows renal mass. MRI shows renal mass.  TREATMENT Surgical removal by nephrectomy. Tumor destruction by radiofrequency ablation. uses heat to destroy tissue. For pain management prevents pain signals from being sent back to your brain. Chemotherapy.  NURSING DIAGNOSIS Fear Impaired skin integrity Risk of impaired urinary elimination NURSING INTERVENTIONS Monitor vital signs Hourly urine output monitoring for changes. for first 24 to 48 hours postoperatively. Monitor intake and output. Monitor hemoglobin and hematocrit as scheduled. Monitor operative site for Monitor for signs of infection postoperatively. redness, swelling, bleeding. Monitor pain level postoperatively. 5. KIDNEY STONES  KIDNEY STONES Kidney stones, also known as renal calculi or nephrolithiasis, occur within the kidneys. Stones can also form elsewhere within the urinary tract. The patient may not have any symptoms from kidney stones until the stone attempts to move down the ureter towards the bladder. Patients develop crystals within the urine. A slow flow of urine gives the crystals time to form a stone. Crystals may be formed from calcium, uric acid, cystine, struvite. Medications such as diuretics can increase the risk of kidney stone formation in some patients.  PROGNOSIS A stone may lodge in the ureter blocking the flow of urine. Hydronephrosis and swelling of the ureter may follow. Kidney stones typically recur, especially in those with a family history of nephrolithiasis. SIGNS AND SYMPTOMS Hematuria Unilateral spasms of pain in the flank area (renal colic) Pain may radiate to lower abdomen, groin, scrotum or labia Nausea, vomiting, and sweating associated with occurrence of pain Elevated blood pressure with pain Extreme flank pain that comes slowly or quickly  TEST RESULTS Urinalysis shows red blood cells. Ultrasound shows stones. X-ray of kidneys, ureters, and bladder (KUB) shows stones. CT scan shows stones. MRI shows stones. TREATMENT Provide pain relief: narcotics such as morphine non-narcotics such as ketorolac, a nonsteroidal anti-inflammatory Administer antispasmodics as adjuncts for pain control. Increase fluid intake to flush through the urinary tract. Lithotripsy—shock waves are used to break the stone into very small pieces that can pass more easily. Stent placement to allow free flow of urine and passage of small stones or stone pieces. Surgical removal of stone.  NURSING DIAGNOSIS Risk of impaired urinary elimination Acute pain NURSING INTERVENTIONS Monitor intake and output. Monitor pain level and response to pain medications. Strain urine to obtain stone for analysis in lab. Teach patient about: Adequate fluid intake. Medications used to reduce chance of recurrence. Dietary modifications needed based on content of stone. 6. PROSTATE CANCER  PROSTATE CANCER Cancer of the prostate typically is found in the peripheral area of the prostate gland. Nodules may be palpable on digital rectal exam. There is a greater incidence as men age. males and those with a family history of the disease have a higher risk for prostate cancer. The symptoms of prostate cancer are the same as those of benign prostatic hypertrophy.  PROGNOSIS Prostate cancer is the most common cancer found in males, and the second leading cancer-related cause of death. The number of cases of prostate cancer found on autopsy are even higher than those found clinically. Screening for prostate cancer has increased the number of cases identified.  SIGNS AND SYMPTOMS Urinary hesitancy—difficulty initiating stream of urine due to pressure on urethra and bladder neck Urinary frequency—need to urinate frequently due to pressure on bladder Urinary urgency—need to get to bathroom quickly to urinate due to pressure on bladder Nocturia—need to get up at night to urinate due to pressure on bladder Decrease in force of urinary stream Intermittent stream of urination Hematuria Palpable nodule on digital rectal examination Urinary retention due to enlargement of the tumor, blocking flow of urine Back pain due to metastasis  TEST RESULTS PSA elevates as tumor size increases. Digital rectal exam may reveal nodule. Transrectal ultrasound used to identify prostate cancer and determine the stage. MRI to identify prostate lesions and involvement of surrounding tissue or lymph nodes. Biopsy to identify cell type. Alkaline phosphatase elevates with metastasis to bone.  TREATMENT Radiation therapy: External beam. Brachytherapy—insertion of radioactive substance into prostate. Surgery—radical prostatectomy. Chemotherapy. Cryosurgery—freezing of tissue with ultrasound guidance. Watchful waiting—monitoring PSA and ultrasound depending on patient’s age and cell type of cancer and any comorbidities. Hormonal treatment to suppress natural androgen production: leuprolide goserelin estrogen Orchiectomy to reduce natural androgen production.  NURSING DIAGNOSIS Fear Impaired urinary elimination Pain NURSING INTERVENTIONS Monitor vital signs. Monitor intake and output. Assess abdomen for signs of bladder distention due to urinary retention. Assess for pain in back. Assess skin for signs of redness or breakdown if undergoing radiation treatments. Monitor for side effects of medications. 7. PYELONEPHRITIS  PYELONEPHRITIS Pyelonephritis is an infection involving the kidneys. Inflammation of the tissue accompanies the infectious process. The most common bacteria are E. coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus. Typically the infection begins in the lower urinary tract and ascends upward. Identification of infections and initiation of treatment is important to prevent the infection from getting worse.  PROGNOSIS Older patients and patients with comorbidities have a greater chance of complications from pyelonephritis. Impaired renal function may complicate recovery in some patients. Septic shock may occur.  SIGNS AND SYMPTOMS Flank pain Fever due to infection Chills Frequency, urgency, dysuria due to urinary tract infection Nausea, vomiting, and diarrhea due to infection Increased heart rate due to fever Costovertebral angle (CVA) tenderness is pain that results from touching the region inside of the costovertebral angle.  TEST RESULTS Urinalysis shows leukocytes, bacteria, nitrites, and red blood cells; may see white blood cell casts. Urine culture identifies organism. Sensitivity shows which antibiotics the organism is most responsive to. CBC shows leukocytosis. is a condition in which the white cell count is above the normal range in the blood.  TREATMENT Administer antibiotics to treat infection—intravenous or oral depending on severity of infection and comorbidities of patient: nitrofurantoin ciprofloxacin levofloxacin ofloxacin trimethoprim-sulfamethoxazole ampicillin amoxicillin Administer antipyretics for fever. Administer fluids for dehydration due to vomiting and diarrhea. Administer phenazopyridine for relief of dysuria symptoms. Repeat urine culture after completion of antibiotic course.  NURSING DIAGNOSIS Impaired urinary elimination Nausea Hyperthermia NURSING INTERVENTIONS Monitor vital signs. Monitor intake and output. Assess for side effects of medication. Teach patient that phenazopyridine will cause orange-colored urine. 8. RENAL FAILURE  RENAL FAILURE A decrease in renal function can occur in an acute (sudden) or a chronic (progressive) manner. Acute renal failure can be broken down into pre-renal, renal, and post- renal. Prerenal causes result from diminished renal perfusion. Hypovolemia due to blood or fluid losses, diuretic use, third-spacing of fluids, reduced renal perfusion due to NSAID use CHF can cause pre-renal failure. Renal failure in acute care patients most commonly results from acute tubular necrosis. Drug related reactions, particularly to antibiotics, may cause an allergic interstitial nephritis. Pylenonephritis or glomerulonephritis may also cause renal failure.  RENAL FAILURE Post-renal failure is due to some type of urinary tract obstruction, bladder outlet obstruction, stone, prostate hypertrophy, compression of ureter due to abdominal mass. Chronic renal failure is an irreversible disease due to damaging effects on the kidneys caused by diabetes mellitus, hypertension, glomerulonephritis, HIV infection, polycystic kidney disease, ischemic nephropathy.  PROGNOSIS In acute renal failure, kidneys start working following intensive treatment and rectifying the underlying condition that caused the problem. In chronic renal failure, the patient can die as a result of complications of the disease.  SIGNS AND SYMPTOMS Azotemia elevated BUN and creatinine If hypovolemic (pre-renal), tachycardia, orthostatic hypotension, dry skin, and mucous membranes Weight loss due to chronic disease Abdominal bruit with ischemic nephropathy Peripheral edema with third spacing of fluids Decreased urinary output Uremic pruritis excoriations from scratching Anemia in chronic disease kidneys produce erythropoietin  TEST RESULTS BUN elevated. Creatinine elevated. BUN/creatinine ratio elevated. Urinalysis may show casts (hyaline or granular in acute prerenal; RBC, WBC in renal), proteinuria. Glomerular filtration rate decreases in chronic disease. Creatinine clearance decreases. Renal ultrasound shows decrease in renal size in chronic renal failure; dilation and fluid build up in post-renal failure.  TREATMENT Administer intravenous fluids to correct hypovolemia. Administer inotropic agents for patients with CHF to enhance cardiac output. Administer antibiotics for pyelonephritis. Stent placement or catheter urethral, suprapubic, nephrostomy to allow for drainage of urine if blockage present. Dialysis. Administer erythropoietin to treat anemia. Restrict potassium, phosphate, sodium, and protein in diet. Administer phosphate binders to reduce phosphate levels. Administer sodium polystyrene sulfonate to reduce potassium levels. Monitor electrolyte levels. Control blood pressure. Control blood glucose levels.  NURSING DIAGNOSIS Impaired urinary elimination Ineffective tissue perfusion (renal) Fear NURSING INTERVENTIONS Monitor vital signs for changes in heart rate or blood pressure. Monitor intake and output. Assess intravenous site for redness, swelling, or pain. Check dialysis access site for signs of infection. Check AV shunt for thrill (palpable turbulence of blood flow; gently feel for flow of blood through shunt) and bruit (audible turbulence of blood flow; listen with stethoscope for sound of blood flow through shunt). No contrast dye tests. No nephrotoxic medication. Monitor patient very closely. 9. TESTICULAR CANCER  TESTICULAR CANCER Cancer involving the testicle typically occurs in males in their teens or twenties. The cancer is hormonally dependent and tends to metastasize fairly quickly to lungs or to bone. A painless nodule may be found by the patient. There is an increased incidence in patients with a history of cryptorchism. Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum.  PROGNOSIS Prognosis is better for patients with solitary nodules that have not had a chance to metastasize. Tumors that have already metastasized to other locations have a poorer prognosis. The diagnosis will also have varied degrees of psychological impact on the patient.  SIGNS AND SYMPTOMS Painless enlargement of the testis Palpable mass on surface of testis Unilateral feeling of heaviness in the scrotum Testicular pain due to bleeding within the testis in a small percentage of patients Back pain due to metastasis Cough or shortness of breath due to pulmonary metastasis  TEST RESULTS Scrotal ultrasound shows mass on testis. CT scan of pelvis, abdomen, and chest may be needed to check for metastasis. Human chorionic gonadotropin (hCG) elevated. these markers are well established to help in the diagnosis, prognosis, treatment and monitoring of testis cancer. Fetoprotein (AFP) elevated. High levels of AFP can be a sign of cancer of the liver, ovaries or testicles. Lactate dehydrogenase (LDH) elevated. it may indicate that certain tissues in your body have been damaged by a chronic (long-term) or acute (short-term) disease or injury. CBC shows anemia later in disease.  TREATMENT Orchiectomy. Chemotherapy, combination medications. Radiation therapy to reduce chance of recurrence. Monitor tumor markers periodically. Monitor follow-up CT scans periodically. Depending on treatments planned, some patients may want to bank sperm, if fertility will be a concern after treatment.  NURSING DIAGNOSIS Fear Anxiety Disturbed body image NURSING INTERVENTIONS Monitor vital signs. Monitor intake and output. Assess patient’s coping abilities. Teach patient testicular self-exam. 10. URINARY TRACT INFECTION  URINARY TRACT INFECTION Urinary tract infection occurs when an infecting organism, typically a gram negative bacteria such as E. coli, enters the urinary tract. Inflammation of the local area occurs, followed by infection as the organism reproduces. Often the bacteria is present on the skin in the genital area and enters the urinary tract through the urethral opening. The organism can also be introduced during sexual contact. The infection occurs as an uncomplicated, community-acquired infection in this setting. Patients with a urinary catheter in place may also develop an infection due to the presence of the catheter which allows a pathway for the bacteria to enter the bladder. Instrumentation of the urinary tract, e.g. cystoscopy, also allows a pathway for bacteria to enter the bladder. Some of the instruments are not completely sterilized between patients; they are treated with a high-level disinfectant due to fiberoptics and lenses within because they would not withstand the high temperatures needed to sterilize. These infections would be considered nosocomial.  PROGNOSIS Urinary tract infections that are identified are typically treated and resolve. Some bacteria have become resistant to certain antibiotics, so testing the urine to be sure the infection has cleared after treatment is a good idea. Infections that are left untreated can progress and travel upward through the urinary tract to involve the kidneys or become a systemic infection or sepsis, especially in elderly or infirm patients.  SIGNS AND SYMPTOMS Frequency due to irritation of bladder muscles Urgency due to irritation of bladder muscles Dysuria due to irritation of mucosal lining Feeling of fullness in suprapubic area Low back pain TEST RESULTS Urinalysis shows leukocytes, nitrites, and red blood cells. Urine culture and sensitivity indicates the infecting organism and the appropriate antibiotic to treat the infection.  TREATMENT Administer antibiotics: nitrofurantoin ciprofloxacin levofloxacin ofloxacin trimethoprim-sulfamethoxazole ampicillin amoxicillin Encourage fluids, to make urine less concentrated. Administer phenazopyridine for symptoms of dysuria. Repeat urine testing after antibiotics are completed.  NURSING DIAGNOSIS Risk of impaired urinary elimination Risk of urge urinary incontinence NURSING INTERVENTIONS Monitor intake and output. Monitor vital signs for changes, signs of fever. Encourage fluid intake. Encourage cranberry juice to acidify urine. Teach patient that phenazopyridine will cause orange-colored urine. DIAGNOSTIC TESTS  CULTURE AND SENSITIVITY TESTS The culture test checks for the presence of bacteria in the urine. The sensitivity test determines what antibiotics can be used to eliminate the bacteria. The laboratory divides the urine specimen in half; one part is cultured to determine which bacteria grow. A preliminary report should be available in 24 hours. The second half is is used to determine to which antibiotics the organism(s) are sensitive. Before the test Explain to the patient that the specimen must be obtained before an antibiotic can be started or the results will be altered.  CYSTOSCOPY This test examines the bladder walls to check for tumors and growths. It is also used as a therapeutic tool to remove small tumors, stones, and foreign bodies to dilate the urethra and ureters. A cystoscope is inserted into the urethra to the bladder, which allows structures to be actually visualized; i.e. urethra, bladder, ureters, and prostate. Before the test Explain to the patient that this test may be performed under general, light or local anesthesia. It will be uncomfortable if the patient is awake. Obtain informed consent.  CYSTOSCOPY After the test Advise the patient to increase fluids to flush out bacteria that may have been introduced with the cystoscope. Bladder muscle spasms may result. The patient should expect some pink urine following the test. Frank, red blood warrants a call to the physician. Observe for signs of a UTI chills, fever, frequent, uncomfortable voiding, pelvic discomfort.  KIDNEY, URETER, BLADDER (KUB) X-RAY STUDY The KUB study is an abdominal x-ray used to detect kidney stones, abdominal abscesses, paralytic ileus or obstruction. Explain to the patient that this is not an invasive procedure.  PROSTATE SPECIFIC ANTIGEN (PSA) TEST This test measures the level of PSA in the blood. The level will be elevated in patients with BPH (benign prostatic hypertrophy) prostate cancer. Elevated PSA levels alone do not give doctors enough information to distinguish between benign prostate conditions and cancer; however, the doctor will take the test results into account when deciding whether to order additional screening for prostate cancer. The test is also used to monitor treatment and to test for recurrences of prostate cancer. Before the test Explain to the patient that rectal and prostate exams, ejaculation, UTI, and prostatitis will all elevate a PSA level.  24-HOUR URINE COLLECTION This is a diagnostic test that involves collecting a patient’s urine for 24 hours. It is typically used to measure volume and various other factors of kidney function as well as to determine the daily elimination of such substances as proteins, electrolytes, etc. Before the test Explain to the patient that the test is started in the morning. Discard the first voided specimen, then save subsequent specimens, ending with the first voided specimen the following day. The urine collection jug should be kept on ice or under refrigeration.  URINALYSIS Urinalysis is the physical, chemical, and microscopic examination of urine. to evaluate the urine specimen for appearance, color, clarity, pH, specific gravity, and the presence of bacteria, blood, casts, glucose, ketones, leukocytes, proteins, RBCs, and WBCs. The tests are used to confirm symptoms of a UTI, to check diabetics for excess glucose levels, to monitor the kidney function of renal patients. Before the test Explain to the patient that many drugs affect a urine specimen. Some samples, as when ascertaining the presence of an infection, may need to be “clean catch” or “midstream clean” collection. The perineum or urethral opening should be cleansed, and the voiding stream started. Without stopping the stream, position the sterile container into the flow of urine. When the container is more than half full, withdraw from the flow of urine. Allow the patient to finish emptying the bladder. Tightly cap and send to the laboratory immediately.  URINE FLOW STUDIES Urine flow studies, also known as uroflowmetry, measure the strength and volume per second of urine flow from the bladder when a patient urinates into a test machine. They help identify an obstruction or abnormality of the urinary tract and assist in evaluating how well or poorly a patient is urinating. Before the test Explain to the patient not to urinate for a few hours before the test and to drink enough fluids to develop an urge to urinate. It is not an invasive test. They will need to void into a flowmeter.  VOIDING CYSTOGRAM This test involves taking an x-ray image of the bladder and urethra during urination. A radiopaque contrast material is instilled into the bladder via a Foley catheter. After x-rays are taken, the catheter is removed. The patient voids while more x-rays are obtained. This test is performed to look for defects of the urinary system, for tumors of the bladder, ureters, urethra, for reflux of urine from the bladder to the ureters. Before the test Explain to the patient that the presence of the catheter will feel like the urge to urinate. Obtain informed consent. Check for allergies to contrast material. Advise the patient to increase po fluids before and after test to aid the kid neys in removal of contrast material.