What to refer to urology

Acute or Urgent Conditions

• Acute urinary retention (especially if failed catheterisation or post-instrumentation).
• Obstructed infected kidney – emergency.
• Complicated pyelonephritis – e.g. with hydronephrosis, abscess, or sepsis.
• Haematuria with clots or clot retention.
• Testicular torsion (immediate referral — surgical emergency).
• Acute scrotal pain/swelling – rule out torsion, epididymo-orchitis, abscess.
• Penile problems: paraphimosis, priapism, traumatic injury.
• Trauma: renal, bladder, or urethral injury.

Non-Emergent but Inpatient Referrals

• Recurrent urinary retention or failed trial without catheter.
• High post-void residuals despite voiding.
• Complicated lower urinary tract infections.
• Macroscopic haematuria for inpatient work-up (if unstable, clotting abnormality, or recurrent).
• Known urology patients admitted under other specialties needing specialist input (e.g. nephrostomy problems, stent issues).

1. Obstructed, infected system

This is a true emergency – urology must be informed urgently.

Have ready:

• Observations: HR, BP, Temp, RR, SpO₂, NEWS score.
• Bloods: WCC, CRP, lactate, U&Es, cultures taken.
• Imaging: CT KUB or renal ultrasound — note stone size, location, presence and degree of hydronephrosis.
• Urinalysis: nitrites, leukocytes, blood.
• Antibiotics: which agent given, dose, and time started.
• Fluid resuscitation: type and volume given so far.
• Urine output: volume and colour; whether catheter in situ.
• Catheterisation details: successful or not; any drained volume recorded.
• Comorbidities: diabetes, CKD, prior stones, urological surgery.
• Anticoagulation: warfarin/DOAC use and last dose.
• Baseline renal function.

2. Renal colic

• Pain status: current severity, controlled with analgesia or not.
• Observations: especially temperature – septic or not?
• Imaging: CT KUB result – stone size, location, any hydronephrosis.
• Bloods: U&Es, creatinine (compare with baseline), WCC, CRP.
• Urinalysis: haematuria present or not.
• Urine output: passed urine since arrival? Any obstruction?
• Analgesia given: NSAID, opioids, antiemetics, and response.
• Hydration status: IV fluids given, tolerance of oral intake.
• Relevant history: previous stones, single kidney, pregnancy, CKD.
• Anticoagulation / bleeding risk.

3. Acute urinary retention

• Bladder scan: pre-catheter volume.
• Volume drained post-catheterisation.
• Urine appearance: clear, cloudy, blood-stained, clots present.
• Catheter type: size, route (urethral/SPC), ease of insertion, any difficulty or trauma.
• Residuals: any bypassing or blockage.
• Symptoms: pain, haematuria, fever, confusion.
• Past urological history: prostate disease, previous retention, catheterisation history.
• Medications: alpha-blockers, diuretics, anticholinergics, anticoagulants.
• Comorbidities: CKD, diabetes, prostate cancer, dementia.
• Imaging: renal ultrasound or bladder scan post-drainage (hydronephrosis?).
• U&Es for post-renal AKI.

4. Visible haematuria with possible clot retention

• Onset and quantity: first episode or recurrent; continuous or intermittent.
• Associated features: dysuria, pain, retention, clots, anaemia symptoms.
• Urine colour: bright red / dark / clots visible.
• Catheter details: size and type, irrigation started or not, urine drainage characteristics.
• Bloods: Hb, U&Es, clotting profile, INR if anticoagulated.
• Medications: anticoagulants, antiplatelets (warfarin, DOACs, aspirin, clopidogrel).
• Imaging: renal/bladder ultrasound or CT urogram if available.
• Past urology history: bladder or prostate cancer, radiotherapy, recent procedures.
• Fluid resuscitation and transfusion history if bleeding is heavy.
• Comorbidities: CKD, malignancy, frailty.

5. Testicular pain / swelling

• Duration and onset: sudden (<6h – torsion) vs gradual (infection).
• Associated symptoms: nausea, vomiting, fever, urinary symptoms.
• Examination findings: lie of testis, tenderness, swelling, erythema, crepitus, cremasteric reflex, discharge.
• Observations: temp, HR, NEWS2.
• Urinalysis: leukocytes, nitrites, blood.
• Past history: prior torsion, epididymo-orchitis, hernia repair, trauma.
• Antibiotics given (if suspected epididymo-orchitis).
• Imaging: scrotal ultrasound (if done — don’t delay for suspected torsion).
• Comorbidities: diabetes, immunosuppression.

6. Catheter problems (blocked, leaking, difficult insertion)

• Type and size of catheter (e.g. 16 Fr Foley).
• Date last changed.
• Reason for current issue: blocked, bypassing, pain, leakage, or trauma.
• Attempts to flush/reinsert: what was tried and outcome.
• Volume in balloon and urine returned.
• Urine appearance: clear, cloudy, blood-stained, no output.
• Symptoms: pain, fever, agitation, palpable bladder.
• Relevant background: chronic catheter use, SPC, urethral stricture, prostate enlargement.
• Comorbidities: anticoagulation, prior urological surgery.
• Observations and any evidence of sepsis.

7. Fournier’s gangrene

• Vital signs: HR, BP, Temp, RR, SpO₂, NEWS2, lactate.
• Extent of involvement: scrotum, perineum, abdominal wall, crepitus present or not.
• Comorbidities: diabetes, immunosuppression, obesity, renal failure.
• Bloods: WCC, CRP, U&Es, lactate, group & save.
• Antibiotics given: drug, dose, and time.
• IV fluids administered and resuscitation progress.
• Catheterisation status: urine output and colour.
• Airway / ITU involvement: if unstable, already escalated?
• Recent trauma, surgery, or perianal infection.
• Allergies and anticoagulation.

8. Urological trauma

• Mechanism: blunt, penetrating, pelvic fracture, iatrogenic.
• Injury details: visible haematuria, flank bruising, urethral bleeding, scrotal swelling.
• Imaging: CT abdomen/pelvis with contrast (if done); note renal injury grade, extravasation, bladder injury.
• Urine output: any drainage, colour, catheter status.
• Catheter attempts: any difficulty, resistance, or urethral bleeding (do not reattempt if traumatic).
• Observations and haemodynamic status.
• Bloods: Hb, U&Es, group & save.
• Comorbidities: CKD, anticoagulation, prior urological surgery.