Policy & Procedure Referral Guidelines:
Urology
I. Purpose: Referral
guidelines are determined to streamline the flow of information from
the primary care physician to the specialist.
II. Policy Statements: For
the specific diagnoses listed below, there are tests and/or reports that
are needed. The test results and/or reports should be sent with the
patient or made available to the specialist prior to the visit.
III. Diagnoses:
(a) Hematuria
1. U/A C & S
2. IVP or renal US and KUB
(b) Recurrent UTI'S adults
1. U/A C & S
2. IVP or renal US and KUB
3. Elderly female: failed
5 week trial of estrogen
4. Young female: failed pericoitus
antibiotics
(c) Stones:
all need an IVP if can be done
(not allergic and one of the following):
1. Demonstrates a stone greater
than 5mm.
2. For stones less than 5mm
- Pain greater than 24h requiring
IM/IV pain meds
- Pain greater than 4 days
requiring oral pain meds
3. Any stone and the presence
of fever or sepsis
4. Any stone in the upper
ureter.
(d) Impotence
1. Free and total serum testosterone
and LH and prolactin if testosterone is low.
2. Failed trial of Yocon if
patient can take the drug.
(e) Peyronies
1. Present greater than 10
mo. and unable to have intercourse.
2. May use trial of Vit E
during the 10 mo.
(f) Incontinence
1. U/A C & S
2. Failed trial of Kegal exercises
for stress incontinence.
(g) BPH (guidelines per Department
of Health and Human Services)
1. U/A, Creatinine, selective
PSA (life span expected longer than 10 y) referral if elevated
Cr with hydro, hematuria, elevated PSA.
2. Failed trial of an alpha
blocker.
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