Pre Appointment Investigations
You may assist your patient by ordering problem-specific investigations, as outlined below. By providing this information at the time of referral or requesting appropriate radiology/pathology we can save the patient potential delays.
Renal Masses
Renal masses are often identified incidentally during workup for other conditions, such as after spinal imaging for back pain.
Radiology:
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.
Testicular Mass
Treatment for men with testicular masses can benefit from the following pre appointment radiology/pathology
Radiology:
All patient with suspected testicular malignancy should be referred with an ultrasound of the scrotum and a chest X-ray.
Pathology:
Please perform serum tumour markers (AFP, bHCG, LDH) as well as baseline blood tests (FBE, UEC, LFTs).
PSA Screening
Men should be referred with 2 or more consecutively elevated PSA’s or an abnormal digital rectal examination finding. These patients would benefit from:
Radiology:
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.
NOTE: Renal tract ultrasound and MRI lack sensitivity for renal and ureteric calculi and are best avoided.
Pathology:
Serum urea and electrolytes, calcium, phosphate, uric acid and parathyroid hormone levels
Urine pH, microscopy and culture
Haematuria
Both microscopic and macroscopic haematuria generally require investigation via cystoscopy and upper tract imaging to rule out malignancy. If possible please ensure patients obtain the following prior to or at the time of referring:
Radiology:
Upper tract imaging in the form of CT intravenous pyelogram if renal function allows, or renal tract ultrasound in the case of renal impairment
Pathology:
Mid-stream urine examination and urine culture
Urine cytology, x 3 samples
PSA in men aged 40 or over
Lower Urinary Tract Symptoms in Men (LUTS)
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:
Radiology:
Renal tract USS, including prostate volume and pre- and post- void bladder volumes
Pathology:
Mid-stream urine examination and urine culture
PSA, urea and electrolytes
NOTE: Prostatic enlargement in the absence of an elevated PSA or LUTS does not require referral.
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.
Radiology:
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.
NOTE: Renal tract ultrasound and MRI lack sensitivity for renal and ureteric calculi and are best avoided.
Pathology:
Serum urea and electrolytes, calcium, phosphate, uric acid and parathyroid hormone levels
Urine pH, microscopy and culture
