GP/Doctors

For GP/Doctors

General Information

To join our rapidly growing community of referrers, please contact the service by phone (1800 246 779) for urgent appointments, or by fax or Argus for routine consultations.

You may aid your patient’s consultation by ordering problem-specific investigations, as outlined below.

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
  • Mid stream urine examination and urine culture
  • Urine cytology, x 3 samples
  • PSA in men aged 40 or above

 

Kidney and ureteric stones

All patients referred with renal or ureteric calculi require a non-contrast CT of the kidneys, ureters and bladders (CT KUB). The only exceptions are patients with obvious contraindications such as pregnancy.

Renal tract ultrasound and MRI lack sensitivity for renal and ureteric calculi, and are best avoided.

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

 

Lower urinary tract 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
  • Mid stream urine examination and urine culture
  • PSA, urea and electrolytes

 

Renal masses

Renal masses are often identified incidentally during workup for other conditions, such as after spinal imaging for back pain.

A triple phase CT scan of the abdomen and pelvis will be required to further characterise the mass. A renal tract ultrasound may also be helpful in cases where a complex cystic mass or angiomyolipoma are being considered.

 

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
  • Mid stream urine examination and urine culture, to exclude false positive PSA levels from concurrent infection
  • Prostate volume as measured on ultrasound, to aid calculation of PSA density

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.

 

Testicular mass

All patient with suspected testicular malignancy should be referred with an ultrasound of the scrotum and a chest X-ray.

Please perform serum tumour markers (AFP, bHCG, LDH) as well as baseline blood tests (FBE, UEC, LFTs).