urology referral guidelines 2012

7/27/2019 Urology Referral Guidelines 2012

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Urology

Urology


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Urology

Telephone Numbers:

H. Gil Rushton, MD, Chief

Administration: 202-476-2681

Administration Fax: 202-476-4739

Clinic Fax: 202-476-4806

Physician Referral Line: 202-476-2670

Schedule Surgery: 202-476-5550

Physician to Physician Access Line: 202-476-4880 33

Consultations and Appointments: 202-476-5042

Evenings and Weekends: 202-476-5000

The Division of Urology at Childrens National Medical Center is the areas largest and most experienced group

of physicians trained especially to treat children with illnesses of the genitourinary tract. Childrens Nationalpediatric urologists have more than 100 years of combined experience in the diagnosis and treatment of all

genitourinary disorders in infants, children, and adolescents. This includes genital reconstruction (undescended

testes, hernias, hydroceles, hypospadias, ambiguous genitalia), evaluation and surgical repair of congenital

and acquired urinary tract abnormalities (hydronephrosis, posterior uretheral valves, vesicoureteral reflux,

neuropathic bladders), evaluation and medical management of daytime and nighttime wetting, urinary tract

infections, and vesicoureteral reflux. Phone consultations from physicians are encouraged. The physician

referral line is 202-476-2670.

Parents may arrange outpatient consultations by phoning 202-476-5042 (option #2). However, evaluation of

children who may need imaging studies for urinary tract infections or hydronephrosis is best arranged through

the hospital office (202-476-5042 option #3). To reduce the number of trips for the family, radiographic and

sonographic evaluation will be arranged for the date of consultation. If studies have been done previously, these

should be sent with the patient at the time of the initial visit.

The Division of Urology compiled the following guidelines to assist referring physicians in the evaluation and

management of pediatric patients presenting with common urological problems. For additional reference, view

Pediatrics, Vol. 110, No 1, July 2002.


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34 Physician Portal: www.ChildrensNational.org/Doctors

Diagnosis/Symptoms Refer to Childrens when Data needed

Phimosis/Non-

Retractable Foreskin

Urinary Tract Infection

Tight foreskin, inability to reduce the foreskin in boys older

than 12 years of age that does not improve treatment with

at least 6 weeks with steroid cream application.

(Betamethasone cream 0.05% applied to foreskin opening

twice a day for 6 weeks.)

Tight phimosis causing ballooning of foreskin with voiding

which persists after treatment with steroid cream as above.

Documentation of recurrent (more than 2 episodes)

infection of the glans (balanitis), foreskin (posthitis), or

both (balanoposthitis).

Documentation of urinary tract infection in males, especiallyif associated with abnormal renal US and/or VCUG; a congenital

urinary tract anomaly (hydronephrosis, vesicoureteral

reflux, posterior urethral valve, prune belly syndrome,

myelomeningocele).

History of paraphimosis (inability to replace foreskin over

glans penis after it has been retracted).

Trauma to the penis, especially the foreskin.

We do not recommend routine referrals for elective,

non-medically indicated circumcisions in boys older than

one month of age.

Any child with documented febrile UTI.

Any male with a documented UTI.

A female with 2 or more occurrences of afebrile

symptomatic UTI.

Document urine clearance after appropriate therapeutic

treatment for a febrile UTI then place the child on

suppressive antibiotics. Prior to the evaluation, children

should be on suppressive antibiotics. (Prophylaxis dose =

1/4 daily dose).

Any child with symptomatic UTI and congenital spinal

dysraphism (myelomeningocele, sacral agenesis) should

be referred to the Spina Bifida Clinic with a requestto see a Childrens urologist.

Clinic notes

Pertinent laboratory data

Clinic notes

Urine culture documentation

(include all)

For patients who have under-

gone US and/or VCUG have

patient bring films or CD to

appointment.

Patients who have not had

studies should call 202-476-

5042 (option #3) to set up

appropriate imaging studies

and consultation atChildrens.


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Physician to Physician Access Line: 202-476-4880 35

Diagnosis/Symptoms Refer to Childrens when Data needed

Voiding Dysfunction,

Daytime Wetting and/or

Nocturnal Enuresis

Undescended testes,

Hydroceles, hernias

Hypospadias

Prenatal

hydronephrosis

Refer to WASH Clinic (Wetting and Soil Help) :

Children older than 7 years with isolated bed wetting.

Children older than 7 years with day and night wetting.

If less than 6 years old.

Refer to a pediatric urologist when:

Any child with a febrile urinary tract infection with abnormal

renal US and/or VCUG

Any child with a congenital anatomic genitourinary anomaly

(posterior urethral valve, vesicoureteral reflux, hydronephrosis,ureteropelvic junction obstruction, bladder or urethral

abnormalities, or genital malformation)

Hydroceles that persist beyond 18 months of age

(hydroceles in infants usually resolve spontaneously).

Reducible hernias.

Testicles should be in the scrotum by 6 months of age.

Referral should be made if that is not the case or if neither

testicle can be felt as a newborn.

Refer between 3-4 months of age.

Unilateral with normal contralateral kidney

refer 3 to 4 weeks of age.

Bilateral or solitary kidney contact pediatric urologist

as soon as possible.

KUB, Urine culture results

KUB and pre/post renal bladder

sonogram, urine culture results

No studies before referral,

Urine culture results

Clinic notes

Urine culture documentation,

if available (include all)

If radiologic studies have beendone, send reports with referral.

The patient should bring films or

CD to the appointment.

No imaging studies should

be done prior to referral.

Sonography rarely adds to

testicular management.

No imaging studies prior to referral

Bring prenatal and postnatal

imaging (films or CD) (postnatal

sonogram at 2-3 weeks of age)

Bring prenatal and postnatal

sonogram films or CD, lab work

urology referral guidelines 2012

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