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Urology Referral Guidelines

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Urology Referral Guidelines Urology Referral Guidelines Department of Health clinical urgency categories for specialist clinics Urgent: A referral is urgent if the patient has a condition that has major functional impairment and/or moderate risk of permanent damage to an organ/bone/tissue/system if not seen within 30 days. Semi Urgent: Referrals should be categorised as Semi Urgent where the patient has a condition that has the potential to deteriorate within 30-90 days. Routine: Referrals should be categorised as routine if the patient’s condition is unlikely to deteriorate quickly or have significant consequences for the person’s health and quality of life if specialist assessment is delayed beyond one month. Exclusions: Austin Health do not perform the following procedures commonly conducted by Urology Units: Refer all erectile dysfunction to Austin’s Men’s Health Clinic Refer all female Bladder Prolapse, Pelvic Prolapse, Cystocele to Mercy or Women’s Hospital Condition / Symptom Criteria for Referral Information to be Expected Triage Austin Specific included Outcome Guidance Notes These guidelines have been set by DHHS: src.health.vic.gov.au Haematuria 1. Any visible haematuria Must be provided: Urgent Instruct patient to bring 2. Persistent microscopic 1. Midstream urine microscopy - Macroscopic films to the Specialist Direct to Emergency Department haematuria: at least 2 episodes culture sensitivities Clinic appointment for: confirmed through midstream 2. Creatinine & Electrolytes (U&E) Semi-urgent specimen of urine collected at 3. Urinary Tract Ultrasound or CT - Microscopic Severe urinary tract least a week apart. Intravenous Pyelogram results bleeding 3. Macroscopic haematuria in the (IVP) absence of a urinary tract infection. Provide if available: 1. Urine Cytology Results Additional comments: 1. Referrals for patients with haematuria with heavy proteinuria should be directed to a nephrology service. These guidelines have been set by DHHS: src.health.vic.gov.au Prostate Cancer 1. Prostate specific antigen (PSA) Must be provided: Urgent Instruct patient to bring (confirmed or >10ng/ml 1. Midstream urine microscopy - Confirmed or Suspected films to the Specialist suspected) culture sensitivities Clinic appointment 2. Initial PSA result of concern Semi-urgent Austin Health Template Referral Guidelines | Created: 25/10/2019 By: Dr Gregory Jack. Last Reviewed: Dr Gregory Jack 25/10/2019. Review & Update By: 24/10/2021. Condition / Symptom Criteria for Referral Information to be Expected Triage Austin Specific included Outcome Guidance Notes 2. Age 50 to 69 years with a repeat 3. Repeat PSA result 1-3 months - Elevated PSA Elevated PSA definitions: PSA test is: 5.5 ng/ml (regardless after the initial test 40-49: PSA >2.5, of the free-to-total ratio) 50-59: PSA >3.5, 3. Between 3.0 ng/ml and 5.5 Provide if available: 60-69: PSA >4.5, ng/ml, with a free-to total ratio >70: PSA >6.5 <25% 1. Urinary Tract ultrasound 4. Age 45 to 69 years with an increased risk of prostate cancer whose PSA is between 2.0 ng/ml and 3.0 ng/ml, with a free-to- total <25% 5. A significant PSA rise where the PSA has previously been low 6. Palpable abnormality in the prostate on digital rectal examination 7. Bone Pain These guidelines have been set by DHHS: src.health.vic.gov.au Recurrent, 1. Women with 3 or more urinary Must be provided: Routine Instruct patient to bring tract infections in a year 1. Midstream specimen of urine - UTI films to the Specialist uncomplicated 2. Women with 2 or more urinary (MSU) - Cystitis Clinic appointment urinary tract infection tract infections in 6 months 2. Urine microscopy culture 3. Men with 2 or more urinary tract sensitivities history (MSU-M/C/S) infections in a year 3. Urinary Tract Ultrasound GP to refer when - Refractory to fluids, Provide if available: hygiene, ovestin, 1. Urea & electrolytes cranberry, D-mannose 2. Blood Glucose Test - Pyelonephritis 3. Bladder Diary - Elevated PVR - Kidney stones Bladder Diary found here These guidelines have been set by DHHS: src.health.vic.gov.au Urinary Continence 1. Urge, stress, mixed or continued Must be provided: Routine Instruct patient to bring incontinence 1. Midstream urine microscopy films to the Specialist culture sensitivities Clinic appointment 2. Urinary Tract Ultrasound Austin Health Template Referral Guidelines | Created: 25/10/2019 By: Dr Gregory Jack. Last Reviewed: Dr Gregory Jack 25/10/2019. Review & Update By: 24/10/2021. Condition / Symptom Criteria for Referral Information to be Expected Triage Austin Specific included Outcome Guidance Notes Direct to Emergency Department 3. Urea & electrolytes for: GP to refer when Provide if available: - Diagnosis, consult, or Unexplained acute 1. Bladder Diary treatment required onset urinary Bladder Diary found here incontinence Symptoms suggest possible neurological emergency Additional comments: Referrals for incontinence due to a neurological disorder should be directed to a neurology service provided by the health service. Referrals for patients with incontinence due to concurrent symptomatic pelvic organ prolapse stages 3 and 4 should be directed to a gynaecology service. Referrals may be directed to a specialist continence clinic or continence service provided by the health service. These guidelines have been set by DHHS: src.health.vic.gov.au Renal Mass 1. Solid or complex renal mass Must be provided: Urgent Instruct patient to bring 2. Renal parenchymal mass 1. Urea & Electrolytes (U&E) - Kidney mass films to the Specialist 3. Angiomyolipoma 2. Urinary Tract Ultrasound or CT - Kidney cancer Clinic appointment 4. Mucosal collecting system lesion Intravenous Pyelogram results - “enhancing” renal cyst 5. Complex cystic lesion (IVP) 6. Large symptomatic renal cyst Semi-urgent Provide if available: - Renal cyst: complex Austin Health Template Referral Guidelines | Created: 25/10/2019 By: Dr Gregory Jack. Last Reviewed: Dr Gregory Jack 25/10/2019. Review & Update By: 24/10/2021. Condition / Symptom Criteria for Referral Information to be Expected Triage Austin Specific included Outcome Guidance Notes 1. Full blood examination (FBE) 2. Urine cytology results Routine - Renal cyst: simple - Renal cyst: benign These guidelines have been set by DHHS: src.health.vic.gov.au Renal Tract Stones 1. Proven calculi in ureter Must be provided: Urgent Instruct patient to bring OR Renal Colic 2. Symptomatic renal calculi 1. Midstream urine microscopy - Ureteral calculi films to the Specialist 3. Asymptomatic renal calculi >5mm culture sensitivities - Ureteral stone Clinic appointment Direct to Emergency Department 2. Urea & Electrolytes (U&E) - Obstructing stone for: 3. Urinary Tract Ultrasound or CT Intravenous Pyelogram results Semi-urgent Acute or severe renal (IVP) - Small (<1cm) renal or ureteric colic stones without Provide if available: Obstruction 1. If the person has passed a - Medullary Sponge Kidney Proven ureteric stone Referral not appropriate for: previous stone and this has been - Staghorn Calculus in people with a single Simple renal cysts examined, include details of - Renal calculus: Large kidney or kidney calculi >1cm transplant 2. Previous imaging of kidney, ureters and urinary bladder Infected or obstructed 3. Full blood examination (FBE) kidney 4. Serum calcium, urate These guidelines have been set by DHHS: src.health.vic.gov.au Lower Urinary Tract 1. Severe lower urinary tract Must be provided: Urgent Instruct patient to bring Symptoms symptoms 1. Midstream urine microscopy - Hydronephrosis films to the Specialist 2. Men with complicated lower culture sensitivities - UPJ obstruction Clinic appointment Direct to Emergency Department urinary tract symptoms: 2. Urea & Electrolytes (U&E) - Ureteral obstruction for: elevated post void residuals 3. Urinary Tract Ultrasound or CT - Ureteral Reflux Bladder Diary found here >150ml, Intravenous Pyelogram results Acute, painful urinary bladder stones (IVP) Semi-urgent retention Hydronephrosis - Bladder Stones 3. Mild to moderate symptoms that Provide if available: - Urinary retention (male have not responded to medical 1. Prostate Specific Antigen history or female) Immediately contact the Urology management (PSA) in Men registrar to arrange an urgent 2. Bladder Diary Routine Austin Health Template Referral Guidelines | Created: 25/10/2019 By: Dr Gregory Jack. Last Reviewed: Dr Gregory Jack 25/10/2019. Review & Update By: 24/10/2021. Condition / Symptom Criteria for Referral Information to be Expected Triage Austin Specific included Outcome Guidance Notes Urology assessment for: - BPH without urinary retention Chronic urinary - Renal cyst: benign retention with deteriorating renal function or Referral not appropriate for: hydronephrosis Mild to moderate symptoms that have not been treated Symptoms that have responded to medical management. These guidelines have been set by DHHS: src.health.vic.gov.au Scrotal Abnormalities 1. Painful swollen testis or Must be provided: Urgent Instruct patient to bring epididymis 1. Scrotal ultrasound - Testicular mass films to the Specialist Direct to Emergency Department 2. Symptomatic hydrocele - Testicular tumour Clinic appointment for: 3. Symptomatic varicocele - Testicular lesion 4. Intermittent testicular pain - Retroperitoneal mass due GP to refer to the Acute scrotal pain suggestive of intermittent Provide if available: to testis cancer Children’s Hospital for testicular torsion 1. Midstream urine microscopy Undescended Testis: Torsion of the testes 5. Chronic or recurrent scrotal pain culture sensitivities Semi-urgent
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