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Adult Urology

Macroscopic Haematuria
  1. Continuous haematuria with clots or clot retention:
    • Phone Urology registrar for acute assessment.

  2. Haematuria without clots or clot retention:
    • Do a MSU to exclude infection. Haematuria associated with infection does not require referral.
      • 2 out 3 MSU specimens must show red cells greater than 20 x 106/L seven days apart
    • Order a Renal Tract USS.
    • Check creatinine.
    • Thereafter refer to urology or renal medicine as appropriate.

Is the incontinence stress or urge?
  • If both, then which is more disabling?
  • MSU
  • Bladder diary (frequency volume chart).
Stress Incontinence:
  • Trial of pelvic floor exercises (3 months minimum). Consider referral to the Continence Service.
  • Refer if significant incontinence is affecting quality of life.
Urge Incontinence:
  • MSU vital to exclude reversible causes e.g. UTI, haematuria.
  • Medication:Refer if symptoms refractory to Vesicare:
    • Oxybutynin 5mg tds - 3 month trial.
    • If unsuccessful, apply for Vesicare (solifenacin) on Special Authority - 3 month trial. Solifenacin is available on special authority if oxybutynin has been trialled and is ineffective or not tolerated. Apply for the authority on line or click here for application form.

Urinary Tract Infection in Men:
  • Refer only after the 2nd urinary infection if UTI uncomplicated i.e. no fever or flank pain.
  • Investigations:

    • DRE
    • MSU
    • Serum Creatinine
    • Order Renal Tract USS

Urinary Tract Infection in Women:

Behavioural modification important:

  • Fluid intake
  • Treat constipation
  • Void after intercourse
  • Cranberry juice
  • Probiotic yoghurts
  • Ovestin cream if perimenopausal may be helpful

While the evidence associated with these measures are not strong, they can be helpful.

If UTIs persist order a Renal Tract USS:

The criteria for a funded Renal USS scan are:

  • > 3 documented UTI's in 6 months, or 6 in a year despite adequate courses of culture specific antibiotics. This pattern implies bacterial persistence rather than recurrence. (Ensure that patient has not previously been investigated with imaging)
  • Recurrent pyelonephritis with no previous imaging.

If USS abnormal, refer.

If USS normal:
  • Take a single dose of antibiotic after intercourse, if this is the precipitating factor.
  • Self-start treatment – women have relevant antibiotics with them to start as soon as symptoms of a UTI develop.
  • If the UTIs are multiple, or frequent, or severe consider a short duration (6 weeks ideally, but up to 3 months) of antibiotic prophylaxis. Use a low dose, culture appropriate agent.

Note: prophylaxis should be a last option, when all other measures have failed. Avoid if at all possible. The obvious risks of prophylaxis are selection of resistant bacteria, as well as significant and irreversible side effects related to long term use of particular antibiotics (e.g. pulmonary fibrosis with Nitrofurantoin).

My Future Care PlanThis plan is for you, to use to write down what you would like your friends, family/whanau, and health professionals caring for you to know.

You can add to this as often as you like, and change your decisions at any time. This is YOUR plan.

You can write down your wishes and preferences. You can share this with anyone who is involved in looking after you.

You do not have to complete this document all at once.

If you would like help completing this document please speak to someone you trust eg. your GP, health professional, family/friend.

Registering the completion of your Future Care Plan (FCP) is very important.

To do this simply take it along to your GP and ask them to complete the following steps on your behalf:

Instructions for GPs:

  • Scan a copy of this FCP to your Patient Management System (PMS).
  • From your PMS create an e-referral to go to Health Records Tauranga (if in the Western Bay) or Health Records Whakatane (if in the Eastern Bay).
  • Attach the FCP document and then send the e-referral.

When received by the District Health Board your FCP will be uploaded into your health record. If you come into hospital, staff will be alerted to the presence of your FCP and be able to provide care accordingly.

Should your wishes change, you can update your FCP at any time. Simply submit a new care plan and it will replace the old one.

Active Surveillance and Watchful Waiting are conservative management strategies for men with prostate cancer. They are two distinct strategies and need to be managed as such. This document gives an explanation of the two terms and aims to provide a structure for follow up for both.

Active Surveillance
The goal of active surveillance is to delay or avoid radical treatment in men with low-risk prostate cancer. The included patients are men with at least 10 years of life expectance who would be good candidates for curative prostate cancer management if evidence of higher-risk cancer was subsequently identified. In essence, these are men for whom a “trigger” is set for radical treatment, and if a certain PSA is reached, or repeat biopsy demonstrates higher-grade cancer, this treatment will be instituted. Due to the potential of these men to have a survival benefit from timely treatment, the Urology department will perform follow up PSA levels and organize imaging and biopsies as appropriate. If you believe your patient is in this group and it is unclear whether Urology Outpatients is following them, please let us know.

Watchful Waiting
This term refers to a group of men with either a proven diagnosis of, or a high suspicion of prostate cancer that are unlikely to ever benefit from curative treatment of their cancer. They will tend to be older men, or those with significant comorbidity, and the intention of follow up is to institute palliative androgen deprivation therapy (ADT) at an appropriate time. Due to the significant adverse effects associated with ADT, therapy is usually delayed until absolutely necessary. As a rough guideline, a PSA doubling time of under 3 months, an absolute PSA level of 50-100, or symptoms possibly caused by prostate cancer (bone pain, lower urinary tract symptoms) may be indications for instituting ADT. PSA levels are usually taken at intervals of between 3 and 6 months. The timing of treatment is not critical as in Active Surveillance, and so monitoring can be carried out by the patients General Practitioner. The clinic letter should clearly state this and any variations to an individuals guidelines, and so if there is any confusion, please contact Urology Outpatients.

Paediatric Urology Guidelines

  • Majority resolve -usually by the age of 24 months.
  • Reassure.
  • If not resolved by age 2- please refer.

Triad of:

  • Hooded foreskin
  • Chrodee
  • Proximal urethral meatus

Usually repaired at 1 year of age.
Refer- no investigations necessary.

New Zealand Resources

Please note

If you cannot find a urology guideline on this page, please check HealthPathways instead - Urology - Community HealthPathways Te Manawa Taki | Midland Region