SUTTER MEDICAL FOUNDATION (SMF) 2800 L Street, 7th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Pediatric Urology Created: 01-2011 Inguinal Hernia…………………………………………………………………………………..Page 2 Major Congenital Anomalies…………………………………………………………………….Page 2 Undescended Testicles…………………………………………………………………………...Page 2 Hypospadias or Chordee………………………………………………………………………....Page 2 Prenatal Hydronephrosis………………………………………………………………………....Page 2 Renal Anomalies…………………………………………………………………………………Page 2 Wilms Tumor…………………………………………………………………………………….Page 2 Urinary Tract Infection…………………………………………………………………………..Page 2 Vesico-Ureteral Reflux…………………………………………………………………………..Page 3 Painless Hematuria……………………………………………………………………………….Page 3 Circumcision……………………………………………………………………………………..Page 3 Nocturnal Enuresis……………………………………………………………………………….Page 3 Neurogenic Bladder……………………………………………………………………………...Page 3 Contact Information……………………………………………………………………………...Page 3 SPA PCP Treatment & Referral Guideline: Pediatric Urology Created: 01-2011 Page 2 of 4 Condition Treatment Inguinal Hernia Immediate Consult Major Congenital Anomalies Consult at Birth (Ambiguous Genitalia, Bladder Exstrophy, Prune Belly Syndrome or Urogenital Sinus Anomaly) Undescended Testicles Nonpalpable Æ Consult at 3 months of age Palpable testis Æ Consult between 3 and 6 months of age Hypospadias or Chordee Consult at 3 months of age Prenatal Hydronephrosis Routine consult, unless severe Æ urgent consult (Male newborns should have VCUG prior to discharge to r/q posterior urethrel valves. If postnatal u/s is normal, repeat u/s in 2 weeks. Neonatal Oliguria hides hydro first 48 hours of life.) Renal Anomalies Duplication of collecting system, megaureter, UPJ obstruction, multicyclic dysplastic kidney, renal ectopy or ureterocele Æ if a VCUG was not done, arrange for one on same day as consult Wilms Tumor Urgent Consult Urinary Tract Infection Routine consult if recurrent or associated with anatomic anomaly. All children should have catheterized specimen for C&S and urinalysis (per AAP guidelines). Treat dysfunctional voiding and constipation. Sonogram Æ All children VCUG Æ all boys regardless of age or fever, all girls under age 7 Is controversial for girls over 7 with fever (pyelonephritis) or recurring infections. SPA PCP Treatment & Referral Guideline: Pediatric Urology Created: 01-2011 Page 3 of 4 Condition Treatment Vesico-Ureteral Reflux Routine consult Treat dysfunctional voiding and constipation. If indicated: Antibiotic prophylaxis Under 3 months of age: amoxicillin or keflex Over 3 months of age: septra or macrodantin Painless Hematuria Nephrology Consult Pediatric Urology Consult: Should be >2-3 RBC/hpf. Check for proteinuria, hypertension, increased urinary calcium clearance. If there is h/o urinary tract infection, prior to urologic problem or stones. Circumcision Pediatric Urology does not do neonatal circumcisions. Treat phimosis with steroid cream (betamethasone 0.05%) applied to tip of foreskin QID for 6 weeks. Circumcision will not be covered by insurance unless there is a medical problem. Nocturnal Enuresis Consult after age 7 Recommend bed alarm. Treat dysfunctional voiding and constipation. Neurogenic Bladder Routine Consult, most patients need to be on clean intermittent catheterization (Spina Bifida, Spinal Cord Injury or Tethering, Sacral Agenesis). Pediatric Urology New Referrals 1-800-482-3284 Eric A Kurzrock, MD, FAAP Pager: 916-762-1302 Jennifer Yang, MD Pager: 916-762-3943 Paula Wagner, FNP Office: 916-734-8482 SPA PCP Treatment & Referral Guideline: Pediatric Urology Created: 01-2011 Page 4 of 4 APPROVAL: _________________________________ SPA/SMF Medical Director January 12, 2011 ___________________ Date Approval/Revision Summary: SMF QM/UM Committee Date: _01-12-2011___________________ SPA Steering Committee Date: FYI Only .