Urology referrals

COVID-19 and Urological Surgery referrals

In common with most other specialties, due to the COVID 19 pandemic, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.

The elderly, the immunocompromised, those with IHD, men and smokers appear to be at greater risk of infection with COVID-19 and these demographics are highly pertinent to our vascular patients. Elective surgery is being greatly curtailed.

We therefore plan to restrict outpatients to urgent referrals.

All suspected cancer referrals will be vetted using the following criteria: Bladder Dip-stix haematuria – Decline, re-refer in 3/12 if GP remains concerned about the patient or if patient develops visible haematuria Visible haematuria – Accept

All Prostate** Age >80 – We will decline* unless PSA >30 Please repeat PSA in 3/12 *Unless symptoms suggestive of metastatic disease, namely bone pain.

PSA > 20 – Will undergo assessment and a bone scan to evaluate for metastatic prostate cancer. If metastatic disease identified : hormone therapy with a repeat PSA in 3 or 6 months depending on the COVID situation.

PSA <20 – ultrasound (abdominal or TRUS)/DRE and estimation of prostate volume PSA density (PSA/prostate volume) is > 0.15ug/l/cc, = prostate biopsy and MRI if available PSA density <0.15ug/l/cc, = reassured, discharged and have a repeat PSA in the primary care setting in 6 months with re-referral if the repeat PSA in 6 months provides a PSA density >0.15ug/l/cc. This PSA value will be listed in hospital correspondence.

**This accepts for some patients there will be a need for clinical judgement and discussion with the on-call urology consultant.

Kidney mass on imaging – Ask the consultant on-call consultant before accepting.

Testis – Accept All

Penile – Accept All

Any suspected ureteric colic will be managed as previously through the EAUS pathway. Stones found incidentally on imaging can be discussed with the on call registrar or consultant.