DOCTORS
REFERRAL GUIDELINES FOR GENERAL PRACTITIONERS
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To join our community of General Practitioner referrers, please contact the service by phone (1800 246 779) or pager (03 9387 1000) for urgent appointments, or by fax (03 8686 1427) for routine consultations.
Haematuria
Both microscopic and macroscopic haematuria require evaluation with cystoscopy and upper tract imaging to rule out malignancy. To this end, please ensure patients obtain the following:
- Upper tract imaging in the form of CT intravenous pyelogram if renal function allows, or renal tract ultrasound in the case of renal impairment
- Midstream urine examination and urine culture
- Urine cytology, x 3 samples
- PSA in men aged 50 or above
Please click here for more information about bladder cancer.
Kidney and Ureteric Stones
All patients referred with renal or ureteric calculi require a non-contrast CT of the kidneys, ureters, and bladder (CT KUB). The only exceptions are patients with obvious contraindications such as pregnancy.
Plain abdominal X-ray (KUB) is useful for identifying uric acid stones, which may be amenable for dissolution therapy. These stones are visible on CT but not on X-ray.
In addition to imaging, please arrange:
- Serum urea and electrolytes, calcium, phosphate, uric acid, and parathyroid hormone levels
- Urine pH, microscopy and culture
Urinary Symptoms in Men
Treatment for men with BPH depends upon the severity of symptoms and anatomical factors such as prostate size. To facilitate assessment, please refer patients with:
- Renal tract USS, including prostate volume and pre- and post-void bladder volumes
- Midstream urine examination and urine culture
- PSA, urea and electrolytes
More information about benign prostate enlargement can be found by clicking here.
PSA Screening
Men referred for an elevated PSA or abnormal digital rectal examination findings would benefit from:
- Free/total PSA ratio, to aid assessment of malignancy risk
- Midstream urine examination and urine culture, to exclude false-positive PSA levels from concurrent infection
Please ensure the patient abstains from sexual activity for 48 hours prior to PSA testing.
Please do not order investigations such as MRI and PET-PSMA. These will be ordered, if necessary, after initial assessment and consultation with the patient.
Kidney Mass
A general practitioner may detect a kidney mass incidentally during workup for other conditions, such as with spinal imaging for back pain.
Please arrange a triple-phase CT scan of the abdomen and pelvis to further characterise the mass. In addition, the patient may require a renal tract ultrasound in the case of a complex cystic mass or angiomyolipoma.
Testis Mass
All patients with suspected testicular malignancy should have an ultrasound of the scrotum and a chest X-ray.
In addition, please arrange serum tumour markers (AFP, bHCG, LDH) as well as baseline blood tests (FBE, UEC, LFTs).