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4 Ophthalmology/ ENT/ ObGyn/Urology/ GUM
PAC 7/2005
4.4 Urology Pathways
The main urology service for LTHT is at SJUH, however during office hours an on call doctor can see patients in the ED.
Care pathways to help improve the management of Urology patients in the department are available on the intranet in the EMIBANK section, and can be printed off from there. Use of these will help ensure the appropriate investigation and referral of these patients. They are summarised below:
4.4.1 Acute Retention
Patients in retention should be catheterised and referred to the Urology SHO at SJUH.
4.4.2 Catheter Related Problem
An attempt should be made to resolve the problem in A&E by un-blocking or re-catheterising. If this is unsuccessful contact the urology SHO on call. If the patient requires transfer to SJUH they should NOT go to A&E there.
4.4.3 Haematuria
There are 3 common clinical pictures here
• If light and clinical picture is UTI discharge with antibiotics with a letter to GP. Ask GP to retest following completion of antibiotics to ensure haematuria resolves.
• If haematuria is frank, and FBC/U&E are normal, and the patient is not thought to be at risk of clot retention and social circumstances permit they can be discharged (encourage high fluid intake). The pathway form (on intranet) can be completed and faxed to the Paul Sykes Centre. The patient will receive an appointment for further appropriate investigation and treatment as an out-patient.
• Finally if blood tests are abnormal, there is clot retention or circumstances do not permit safe discharge they should be referred to the Urology SHO and admitted.
4.4.4 Ureteric Colic
A history consistent with renal colic in any patient over 60 is an abdominal aortic aneurysm until proved otherwise
A CDU protocol should be followed for these patients
Remember adequate analgesia with IV opiates and NSAIDs (currently PO).
All patients with proven stone disease should be referred to urology.
4.4.5 Unilateral Testicular Pain
• Torsion
Commonest in the neonatal period and around puberty
Classically presents with severe abdominal pain and vomiting
Occasionally the pain is entirely abdominal
Examination shows a red swollen tender testis
The opposite testis may lie horizontally rather than vertically (Angell’s sign)
Possible torsions are a surgical emergency and should be referred to urology or to paeds surgery.
• Epididymo-orchitis
< 35 is most likely an STD
>35 usually secondary to UTI
Classically
Gradual onset progressive testicular ache
Subsequent swelling of testis and epididymis
May be dysuria and discharge
Acutely tender epididymis and scrotal reddening
Testis may lie low in the scrotum
A sexual contact history should be taken
< 35 years old (or STD more likely than UTI)
Doxycycline100mg bd for 14/7
Allergy to tetracyclines
Ofloxacinn200mg bd for 14/7
A faxed request for follow up in the Centre for Sexual Health (GUM clinic) should be completed and sent and abstinence from intercourse advised. Appropriate advice leaflets are in the pathway documentation.
>35 years old
Ciprofloxacin 500mg bd for 10/7
If there are symptoms and signs of urological disease the patient should be referred to the urology SHO. Otherwise discharge with a letter to the GP
Advise bed rest, simple analgesia