Medical assistant's role in urinary examinations and treatments

As with other physical examinations, a careful history provides the physician with valuable information. The medical assistant should ask specific questions to gather important information on the patient’s chief complaint for the visit. For instance, if a patient states, “I think I have a bladder infection,” the medical assistant should focus on what signs and symptoms the patient is experiencing and not just document what the patient stated. For this type of situation, the medical assistant may ask the following questions:

• What is occurring now? When did it start?
• Have you had a history of bladder infections?
• Are you experiencing pain or discomfort? Where? When?
• Any urgency or the need to go “now”? Are you going more frequently?
• Is there blood in the urine?
• Any fevers? Chills?

Remember to start with more open-ended questions; in other words, use questions that encourage the patient to answer in more than just one or two words. To get specific details, the medical assistant can ask questions that are closed ended or those that require one- or two-word answers, such as yes or no.

Testicular self-exam

According to the American Cancer Society, males at any age can develop testicular cancer. About 50% of those diagnosed are between 20 and 34 years of age. It is estimated that 1 in 263 males will get testicular cancer. If the cancer is found early (before it has spread), there is a good chance of a cure.

The American Cancer Society recommends that providers perform a testicular exam as part of a routine physical exam. Some providers recommend that after puberty (around age 15), males should do a monthly testicular self-exam (TSE) after a shower. The medical assistant may be involved in coaching a patient on how to do a TSE. Procedure 42.1 discusses how to coach a patient on the TSE. It is helpful for the patient to have a brochure and practice the technique on a TSE model during the coaching session.

Assisting with diagnostic procedures

The medical assistant helps with diagnostic procedures by scheduling and preparing patients for these procedures. If tests require restrictions of food or fluids, the medical assistant should address the following points with the patient after talking with the provider:

• Can the patient have water prior to the test?
• Which medications should the patient take prior to the test, or when can the patient resume the current medications?

Medical Assistants should become familiar with the common diagnostic procedures used for urinary and male reproductive conditions. The medical assistant may need to screen the patient for specific allergies, medications, and pregnancy prior to scheduling the procedure. For some procedures, a signed consent form is required. The patient should be notified of what they will experience during the procedure and any follow-up care required after the test.

Assisting with treatments for urinary and male reproductive disorders

Treatments for urinary and male reproductive disorders vary. The following sections examine treatments for both body systems.

Treatments for urinary system disorders

Common treatments used for urinary system disorders include the following:

• Catheterization: The insertion of a catheter to drain urine from the bladder. An indwelling catheter remains in, and a straight catheter is removed after the procedure.
• Dialysis: A technique in which filtration through a semipermeable membrane is used to remove metabolic wastes and extra fluid from the blood.
• Extracorporeal shock wave lithotripsy (ESWL): A nonsurgical approach that uses shock waves to break up stones in the ureters and kidneys.
• Kidney transplantation: Surgical transplantation of an entire kidney from a donor to a recipient.
• Nephrectomy: Surgical removal of a kidney. There are several types of surgical procedures:
• Partial nephrectomy: Removal of cancer and surrounding tissue; kidney remains functional; used when the other kidney has been damaged or removed
• Simple nephrectomy: Removal of the kidney
• Radical nephrectomy: Removal of the kidney, adrenal gland, surrounding tissue, and local lymph nodes
• Nephrolithotomy: A surgical incision of the kidney to remove a stone. The surgeon makes a small incision on the lower back to reach the kidney, and a nephroscope is inserted with other instruments to remove the stone. With percutaneous nephrolithotripsy (PNL), the stones are crushed and removed using suction.
• Nephroureterectomy: Surgical removal of the kidney and ureter.
• Segmental resection of the ureter: Surgical removal of the diseased section of the ureter; ureter is then reconnected.

Urinary catheterization

A urinary catheter is a hollow, flexible tube that is inserted into the bladder through the urethra. It is used to collect urine. There are two primary types of urinary catheters:

• An indwelling Foley catheter is used to help patients who are unable to void (urinate) on their own. It is placed with the tip in the bladder and left in place to allow urine to be removed from the body and drained in a collection bag. The tip of the catheter contains a balloon, which is filled using a syringe. This holds the catheter in the bladder. A coudé-tip catheter, which has a slightly curved tip, can be used if a person has an obstruction, such as enlarged prostate glands.
• A straight catheter is used to collect a sterile urine specimen. It is inserted into the bladder, a specimen is obtained, and then the catheter is removed.

Some facilities and state statutes allow medical assistants to insert catheters. The medical assistant must use the correct-sized catheter to prevent tissue damage. Catheter sizes are measured in French gauge (Fr). Pediatric patients generally use 9-12 Fr, and adults may use 12-18 Fr catheters. The medical assistant should check with the provider if there is a question on the size of catheter to use. It is critical that the medical assistant insert the catheter using sterile technique to minimize the risk of a urinary tract infection (UTI).

Discontinuing indwelling catheters

Depending on the state statutes and the facility’s policy, the medical assistant may discontinue indwelling catheters. Sometimes after an indwelling catheter is removed, the patient may have urinary retention (inability to void) or void small amounts, not emptying the bladder as normal. The patient may experience the following:

• Abdominal discomfort and pain
• If voiding, a weak stream, voiding small amounts
• Urinary incontinence

Patients should be instructed to monitor when and how much they void. Usually, a person should void 6 hours after the removal of an indwelling Foley catheter. Patients who suspect an issue should call the provider immediately.