Adult Urology Clinic Consult and Referral Guidelines

Diagnosis/Symptom

Initial Workup

Referral When

Hematuria

1. Gross hematuria or two documented microscopic
   urine analyses positive for blood (>5 rbc/hpf) in the
   absence of infection.

2. Serum Creatinine
3. IVP or CT IVP

Documented UA’s strictly required for all referrals.

If pt has completed UA’s and IVP/CT IVP, patient can
Qualify for single expedited cystoscopy procedure visit

Recurrent UTI

Documented >3 positive
Urine C&S within 1 year.

Consider trial prophylaxis for 6 months: Nitrofurantoin
50mg every night or DS Septra every night.

BPH

1. PSA test
2. Urinalysis

Patient has been on alpha blocker (Flomax 0.4mg or
Cardura 4-8mg) for at least one month and persistent
moderate to severe lower urinary tract symptoms with
negative urinalysis

Prostate Cancer

PSA test

Prostatitis

1. Rectal exam
2. Urine C&S
3. Expressed Prostate secretion C&S or Urine C&S obtained after prostate massage.

Antibiotic treatment (Quinlones vs. Trim/Sulfa) for 6 weeks and NSAIDS-Ibuprofen.

Incontinence
     Female

1. Pelvic exam
2. Urinalysis C&S

Failure of drug therapy for overactive bladder, Ditropan 5mg TID or Detrol 2mg BID.

Incontinence
     Male 

Urinalysis

1. Residual Urine measurement

Kidney Stone

1. CT-KUB
2. Pain control

• Small stones <5mm without hydronephrosis are

Allowed to pass and patient is asked to increase fluid
Intake.

• Follow up in one month.
• Patient is asked to strain urine.
• Patients with hydronephrosis (no matter what size of stone) are seen as soon as possible.
• Patients with indwelling stents placed at outside

Facilities are only seen after direct urologist to urologist
communication.

• Patients outside of King County are only seen if referral approved by Urology Chief after direct
  urologist to urologist communication.

Philmosis/Balantis

Antifungal or antibiotic
Treatment

Refer only for circumcision.

Epididymo-orchitis

Scrotal Ultrasound

Antibiotic plus NSAID medications for 10-14 days.
Scrotal support.

Peyronies Disease

Physical exam

Conservative Management: Colchicine 0.6 mg BID (WBC
at 1 month), vitamin E 400 IU BID.
Refer for surgical correction of severe curvature or pain
not responsive to medications.

Impotence

1. Physical examination
2. Testosterone and PSA levels

Refer for failure of Viagra 50mg then 100mg for at least 8 attempts.

Laparascopic Kidney
Procedures

Imaging studies of kidney

Penile and
Reconstructive Surgeries