EDMONTON ZONE Urology REFERRAL QUICK REFERENCE

1 Reason for ReferralAccess TargetProcess/InstructionsEssential LabsEssential Imaging (attached or ordered)Timing for Essential Investiga-tionsExtra Information (if applicable)Abnormal DRE - (new diagnosis)< 4 weeksUrgent REFERRAL to UrologyCall NAUC REFERRAL & Triage , urine culture, PSA x 2< 3 monthsAdrenal Mass< 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, random glucose, cortisol, 24 hour urine metanephrinesCT or MRI (abdomen)< 3 monthsBalanitiseReferral Advice Request Create using Urology Issue(BPH) Benign Prostatic Hyperplasia< 3 monthseReferral Consult RequestCreate using BPH (Benign prostatic hyperplasia)Lytes, creatinine, U/A, PSA if 50-70 yrs with 10 year life expectancy< 6 monthsConsult Request only accepted if docu-mented failed trial of Tamsulosin (Flomax)

2 And should include baseline IPSS form, post-treatment IPSS and voiding diaryBladder DiverticulumeReferral Advice Request Create using Urology IssueLytes, creatinine, U/A< 6 monthsInclude list of trialed Alpha Blockers medicationsBladder Mass< 2 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, U/A, urine cytology x 1< 30 days Ultrasound results showing the massBladder Stone< 3 monthseReferral Consult Request Create using Kidney Stone Chronic (non-obstructing)U/A, urine culture KUB X-Ray and renal colic CT or KUB and abdominal ultrasound3 monthsEDMONTON ZONE Urology REFERRAL PATHWAYeReferral Advice RequestLog into Alberta netcare ( ) and electronically submit your questions and pertinent documents.

3 You will receive a response within five calendar you do not have Alberta netcare , but have a non-urgent question, contact:Northern Alberta Urology Centre (NAUC) / Kaye EDMONTON Clinic Alberta Health Services7th Floor, Kaye EDMONTON Clinic11400 University AvenueEdmonton, AB T6G 1Z1 Referrals Department - Telephones: 780-407-5800 Refer patients to outpatient clinics*Indicate a clear reason for REFERRAL and any confirmed diagnosis to assist in directing your all required information and speci ic tests/investigations as per the Urology REFERRAL ADVICE A Urologist will provide advice to physicians for non-urgent questions NON-URGENT CONSULTATION Patient DOES NOT need to be seen within four weeksCall directly to the Northern Alberta Urology Centre, REFERRAL & Triage Department - 780-407-5800 IMPORTANT NOTE.

4 Contact NAUC REFERRAL & Triage Department BEFORE submitting an eReferral directly to the emergency department or call RAAPID North: 1-800-282-9911 and ask forthe Urologist to emergency for:- Acute Scrotal Pain- Testicular Torsion- Acute Renal Colic- Genitourinary Trauma- Genitourinary Tract ForeignBodyEMERGENCY CONSULTATIONP atient NEEDS to be seen immediately- Recurrent Urinary Tract Infection inFemales - Refer to Urinary Tract ClinicalPathway (attached).- Complicated UTI (fever, hematuria),diabetic or immune UPDATED Nov. 26, Zone Urology REFERRAL Pathway1 URGENT CONSULTATIONP atient MAY NEED to be seen within two - four ZONE Urology REFERRAL PATHWAY2 Reason for ReferralAccess TargetProcess/InstructionsEssential LabsEssential Imaging (attached or ordered)Timing for Essential InvestigationsExtra Information (If applicable)Cystocele< 6 monthseReferral Consult Request Submit using CystoceleLytes, creatinine, U/A, urine culture< 3 monthsElevated PSA(no previous cancer)< 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , urine culture, PSA x 2< 3 monthsElevated PSA(previous cancer)

5 < 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , urine culture, PSA x 23 monthsErectile Dysfunction< 6 monthseReferral Consult RequestCreate using Erectile DysfunctionCBC, lytes, creatinine, TSH,testosterone, fasting glucose, lipids, cholesterol, triglycerides< 6 monthsConsult Request if failed trial of PDE 5 inhibitorsFemale Voiding Dysfunction< 6 monthseReferral Consult RequestCreate using Female VoidingDysfunctionU/A, urine culture< 6 monthsPatient to bringvoiding diary toappointmentHematospermiaeReferral Advice Request Create using Urology Issue Hematuria Gross< 2 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , lytes, creatinine, urine culture, urine cytology x1 Renal ultrasound or CT urogram< 30 daysHematuria Microscopic (greater than 3 rbc/hpf)< 3 monthseReferral Consult Request Create using Hematuria Microscopic (greater than 3 rbc/hpf)Creatinine, U/A x 2, urine cytology x 1, urine cultureRenal ultrasound< 6 months- U/A must beuncontaminated; Dip is not sufficient.

6 Hydrocele< 6 monthseReferral Consult Request Create using HydroceleScrotal ultrasound< 6 monthsHydronephrosis< 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, U/ARenal bladder ultrasound3 monthsHypospadiuseReferral Advice Request Create using Urology IssueIncontinenceeReferral Advice Request Submit using Urology Issue U/A, urine culture< 6 monthsKidney Stone (acute/ureteric)< 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, U/AKUB X-Ray and renal colic CT or KUB and abdominal ultrasound2 weeksKidney Stone Chronic (non-obstructing)< 3 monthseReferral Consult Request Create using Kidney Stone Chronic (non-obstructing)Lytes, creatitine, Ca, PTH, U/AKUB X-Ray and renal colic CT or KUB and abdominal ultrasound3 monthsLow Testosterone< 3 monthseReferral Consult RequestCreate using Male Sexual DysfunctionFSH, testosterone, LH, prolactin Semen analysis x 2 (Three months apart) at a Fertility Clinic6 Zone Urology REFERRAL QUICK ReferenceUPDATED Nov.

7 26, 2018 EDMONTON Zone Urology REFERRAL PathwayEDMONTON ZONE Urology REFERRAL PATHWAY3 Reason for ReferralAccess TargetProcess/InstructionsEssential LabsEssential Imaging (attached or ordered)Timing for Essential InvestigationsExtra Information (if applicable)Lower Urinary Tract Symptoms (LUTS)< 3 monthseReferral Consult RequestCreate using Lower Urinary Tract Symptoms (LUTS)Lytes, creatinine, U/A, PSA if 50-70 yrs with 10 year life expectancy< 6 monthsConsult Request only accepted if documented failed trial of Tamsulosin (Flomax) and should include baseline IPSS form, post-treatment IPSS and voiding diaryMale Infertility< 3 monthseReferral Consult RequestCreate using Male Infertility FSH, testosterone, LH, prolactin, semen analysis x 2 (three months apart)

8 At Fertility Clinic< 6 monthsMale Sexual DysfunctioneReferral Advice Request Create using Urology IssueCBC, lytes, creatinine, TSH, testosterone, fasting glucose, lipids, cholesterol, triglycerides< 6 monthsPelvic Organ Prolapse< 6 monthseReferral Consult Request Create using Pelvic Organ ProlapseLytes, creatinine, U/A, urine culture< 3 monthsPenile Mass< 2 weeksUrgent REFERRAL to UrologyCall NAUC REFERRAL & Triage Disease< 6 months1. eReferral Advice Request if mildCreate using Urology Issue2. eReferral Consult RequestCreate using Peyronies DiseaseTestosterone, fasting glucose, lipids, cholesterol, triglycerides< 6 monthsPatient to bring picture of erection to appointmentPhimosis< 3 monthseReferral Consult RequestCreate using PhimosisPatient to have trialed Kenacomb cream for two monthsRenal Cyst eReferral Advice Request Create using Urology Issue Lytes, creatinine, U/A Abdominal ultrasound and CT abdomen or MRI abdomen < 3 monthsRenal Mass > 4 cm< 2 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, CBC, alk phos, ALT, total bilirubin, Ca, PO4, LDH, PT INR.

9 U/AChest X-Ray and abdominal ultrasound or CT abdomen< 3 monthsRenal Mass Solid < 4 cm< 4 weeksUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , creatinine, CBC, alk phos, ALT, total bilirubin, Ca, PO4, LDH, PT INR, U/AChest X-Ray and CT abdomen< 3 monthsSpermatocele eReferral Advice Request Create using Urology IssueScrotal ultrasound< 6 monthsTesticular Mass, Solid< 1 weekUrgent REFERRAL to Urology Call NAUC REFERRAL & Triage , BHCG, LDHS crotal ultrasound< 2 weeksTesticular MicrolithiasiseReferral Advice Request Create using Urology IssueScrotal ultrasound< 6 monthsTesticular Pain Chronic (non - STD)eReferral Advice Request Create using Urology IssueU/A, urine cultureScrotal ultrasound< 6 monthsEdmonton Zone Urology REFERRAL Nov.

10 26, 2018 (2018) AHS. This material is intended for general information only and is provided on an as is , where is basis. AHS does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional. AHS expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such for ReferralAccess TargetProcess/InstructionsEssential LabsEssential Imaging (attached or ordered)Timing for Essential InvestigationsExtra Information (if applicable)Undescended Testicle with Negative BHCG and AFPeReferral Advice Request Create using Urology IssueUrachal CysteReferral Advice Request Create using Urology IssueAbdominal ultrasound< 3 monthsUrethral Strictures< 3 monthseReferral Consult Request Create using Lower Urinary Tract Symptoms (LUTS)