Genitourinary disorders are diseases experienced when the genital and urinary organs function improperly. In most cases, such disorders are associated with injury, illnesses, and aging. The genitourinary disorders appear in different forms including interstitial cystitis, urinary incontinence, kidney stones, neurogenic bladder, urinary tract infection, prolapsed uterus, and pelvic inflammatory disease. Apart from these disorders causing urinary problems, they can also affect an individual’s reproductive systems. The genitourinary illnesses are life-altering as they affect the quality of life.
Diagnoses are meant to help physicians to detect and act on the disease, however, some diagnoses cause flank pains including trauma, pyelonephritis, and urinary tract infections.
- Pyelonephritis is a diagnosis that has been found common with preschool children. This disease is flanked by pain and other febrile diseases, such as emotional stress, chronic recurrent abdominal pain, early appendicitis, and gastrointestinal syndromes (Santos, Lopes, & Koyle, 2017).
- Urinary tract infection (UTI) is a common urinary infection. Diagnosis is based on the accurate urine culture findings which reveal that the individuals with the disease experience bad smelling urine or looking reddish or cloudy (Nelson, 2016). The patient always feels an urge to urinate, as well as feeling pain during urination. The individual with UTIs would experience pain in the back, tiredness, fever, or shakiness.
- Intersex abnormalities which involve physical examination to help determine the anatomical classification (Burns, 2013). This is evident when the syndrome is associated with cryptorchidism.
Primary diagnosis and rational
The initial evaluation of patient’s conditions will involve physical and clinical history examination. Bowel and voiding diaries will offer relevant and reliable information about the condition of the patients (Santos et al., 2017). The diary should be based on a 48-72-hour reading; therefore, the records of patient’s urine volumes can be estimated in terms of the maximum voided volumes. With the help the Bristol stool chart, it is possible to monitor and diagnose constipation treatment response, especially for children with balder bowel dysfunction.
Orders to address the issues
Based on the urgency to address this syndrome, I will give orders covering behavioral, pharmacological, and surgical treatment plans.
Parents, caregivers, and children must be educated on urotherapy because this is the only non-surgical and non-pharmacological treatment method available (Burns, 2013). The orders will encompass:
- Caregivers and parents must ensure adequate hydration
- Conduct pelvic floor muscle awareness
- Undertake timed avoiding
- Conduct bowl regiment through stool softeners, optimal hydration, and high intake of dietary fibers
The urotherapy will maximize contraction and relaxation of muscles.
When the urotherapy fails to yield expected outcomes, pharmacological treatment should be the second option. Patients with chronic conditions need long-term treatments using different anticholinergics (Santos et al., 2017). The adult patients should use any of these anticholinergics depending on the physician’s prescriptions:
In a situation where a patient has experienced the disorder for over nine months, it would be prudent to recommend surgical treatments including:
- Refractory detrusor overactivity: In children, sacral transcutaneous stimulation is advisable because it lacks negative side effects, especially in children with symptom severity and bowel bladder dysfunctions (Santos et al., 2017).
- If the maximum medical therapies, such as enema therapies, medications, and diet fail, an antegrade continence enema procedure should be considered (Santos et al., 2017). This will help to handle cases of intractable defecation disorders.
These orders, however, should only guide the patient, physician, and families in making individualized informed decisions to meet the patient’s needs.
Patient and parent education
Education and reassurance relating to the syndrome should focus on the repair, etiology, and outcome. In fact, the need for a careful assessment of children or newborn should be conducted, especially, when cases of hypospadias had been reported in the family. Nonetheless, hypospadias is a unique and isolated glitch which needs further workups so as to assess for other anomalies within the urinary system anatomy. Patient education should focus on encouraging patients to accept further assessments on their urinary systems to detect any anomalies (Burns, 2013). As such, it is possible to undertake responsive and early steps to salvage the situation. Besides, the practitioner should share with the families relevant educational materials because of the growing frustrations, anxiety, and concerns regarding the persistent wetting. These educational materials should include handouts, brochures, and videos should give the parent an opportunity to opt for the urotherapy while pursuing medical interventions (Santos et al., 2017). These efforts will improve treatment compliance. However, these educational materials must be composed of simple language and they should contain the general information about bladder dynamics, urinary tract anatomy, causes of the disease, natural history, and tips on appropriate postures and position.
The impact of culture
Health beliefs remain a significant factor in mediating between an individual’s behaviors and experience of symptoms. These health beliefs vary from one ethnic group to another (Welch, Botelho, & Tennstedt, 2011). In most cases, many people attribute such syndrome to personal behaviors or aging; hence never find it amenable to seek medical treatment. The Black Americans associate the genitourinary disorders to personal behaviors which make it difficult to control. However, the Hispanics treat the disease with uncertainty regarding the symptoms and the future health consequence. Consequently, the combination of different health beliefs seems to determine the behavior of individuals in seeking medical care. The cognitive representations are shaped by the socio-cultural differences. To this effect, patient education and assessment depend on the cultural competency.
- Burns, C.E. (2013). Pediatric Primary Care, (5th Ed.). Philadelphia, PA: Sounder Elsevier.
- Nelson, C.P. (2016, May 31). Pediatric Vesicoureteral Reflux. Medscape. Retrieved from https://emedicine.medscape.com/article/1016439-overview.
- Santos, J.D., Lopes, R.I., and Koyle, M.A. (2017). Bladder and Bowel Dysfunction in Children: An Update on the Diagnosis and Treatment of a Common, But Underdiagnosed Pediatric Problem. Canadian Urological Association Journal, 11(1-2 Suppl. 1), S64-S72.
- Welch, L.C., Botelho, E.M., and Tennstedt, S.L. (2011). Race and Ethnic Differences in Health Beliefs about Lower Urinary Tract Symptoms. Nursing Research, 60(3), 165-172.