< 4 Weeks
Alternate name: Abnormal DRE (new diagnosis)
Process: Send referral to Zone FAST Team.
< 4 Weeks
- EElectrolyte panel (Sodium, Chloride, Potassium andBicarbonate)-note if using paper requisition please write“electrolyte panel”
l- Creatinine, random glucose, cortisol, 24-hour urinemetanephrines
- CT or MRI abdomen
Alternate name: Adrenal Mass
Access Targets:
<4 weeks: <4cm size
<2 weeks: >4cm size (urgent)
Process: Send referral to Zone FAST Team.
Confirm with contrast enhanced CT/MRI
Angiomyolipoma (<4cm)
ASK FOR ADVICE: Contact the local Urologist office directly
Angiomyolipoma (>4cm)
Send referral to Zone FAST Team
Process: Contact the local Urologist office directly
< 1 Month
Alternate name: Bladder Fistula (documented)
Process: Send referral to Zone FAST Team.
< 2 Weeks
Alternate name: Bladder Mass
Process: Send referral to Zone FAST Team.
< 3 Months
Alternate name: Bladder Stone
Process: Send referral to Zone FAST Team.
< 3 Months
Simple renal cysts do not require consultation or further imaging.
Alternate name: Renal Cyst
Access Target: < 2 weeks for urgent
Process: Send referral to Zone FAST Team.
< 6 Months
Alternate name: Urethral Disorder (female)
Process: Send referral to Zone FAST Team.
< 6 Months
Urinalysis
Urine culture
Renal bladder ultrasound (no x-ray needed)
Alternate name: Female Voiding Dysfunction
Process: Send referral to Zone FAST Team.
Elevated PSA with no previous prostate cancer
< 4 Weeks
Urinalysis
Urine culture (if urinalysis abnormal)
Prostate-specific antigen (PSA), 2 tests done at least 4 weeks apart.
Alternate name: Elevated PSA (no previous prostate cancer)
Process: DRE recommended. Review clinical pathway
Send referral to Zone FAST Team
Elevated PSA with previous prostate cancer
< 4 Weeks
Urinalysis
Urine culture (if urinalysis abnormal)
Prostate-specific antigen (PSA), 2 tests done at least 4 weeks apart.
Alternate name: Elevated PSA (previous prostate cancer)
Process: DRE recommended. Review clinical pathway
Send referral to Zone FAST Team
< 6 Months
Scrotal ultrasound (must include measured dimensions of cyst)
Alternate name: Epididymal Cyst
Symptomatic > 1 cm, spermatocele.
Process: Send referral to Zone FAST Team.
< 6 Months
AM total testosterone (to be completed within the hours of 0800-1000)
Process: Send referral to Zone FAST Team.
Other information:- Refer only if patient has failed 2 different PDE 5 Inhibitors x 5 Consecutive Doses (each) or additional
trials could not be completed. - Confirm patient interest in penile injection therapy or surgery prior to referral
Female urinary-genital tract fistula
< 3 Months
Alternate name: Fistula - Female Urinary Genital Tract
Process: Send referral to Zone FAST Team.
< 3 Months
Alternate name: Foreskin Problems (includes Phimosis)
Process: Send referral to Zone FAST Team.
Other information: Patient must have failed a two-month trial of a steroid cream prior to referral.
< 2 Weeks
Alternate name: Hematuria Gross
Process: Send referral to Zone FAST Team.
< 6 Months
Urinalysis
Urine culture
PSA, if between age 40-75
Abdominal and pelvic ultrasound
Process: Request non-urgent advice: Contact Lethbridge Urology Surgeons at 403-524-1411 or Dr. Talal Alphin (Medicine Hat) at 403-528-2912.
< 6 Months
Scrotal ultrasound (must include dimensions of hydrocele)
Alternate name: Hydrocele
Process: Send referral to Zone FAST Team.
Other information: Must be symptomatic and clinically detectable on exam.
< 4 Weeks
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Renal and bladder ultrasound
If patient had CT, ultrasound is not necessary.
Process: Send referral to Zone FAST Team.
Process: Send referral to Zone FAST Team.
< 2 Weeks
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Kidney Ureter Bladder (KUB) x-ray. Referrals missing KUB x-ray will not be accepted
Renal colic CT or abdominal ultrasound
If discrepancy between KUB x-ray and abdominal ultrasound, consider a CT scan
Alternate name: Kidney Stone (Acute/Uteretic)
Process: Send referral to Zone FAST Team.
Lower urinary tract symptoms
< 6 Months
Renal and bladder ultrasound
Urinalysis
Alternate name: Lower Urinary Tract Symptoms (male LUTS)
Access Target: < 2 weeks for urgent
Process: Send referral to Zone FAST Team.
Other information: Includes BPH, urethral strictures, prostatitis, male chronic pelvic pain. For BPH, patient must have failed a one-month trial of tamsulosin (Flomax) prior to referral.
< 3 Months
- Semen analysis
- FSH
- AM total testosterone (to be completed within the hours of 0800-1000)
- LH
- Prolactin
- Estradiol
Process: Send referral to Zone FAST Team.
< 6 Months
Referrals for low testosterone or hypogonadism require the following:
- AM total testosterone (to be completed within the hours of 0800-1000)
Male Sexual Dysfunction
Includes low testosterone, hypogonadism, ejaculatory dysfunction, rapid ejaculation
Process: Contact the local Urologist office directly.
< 2 Weeks
CBC and INR
Abdominal/pelvis CT with contrast
Alternate name: Penile Mass (cancer concern)
Process: Send referral to Zone FAST Team.
< 3 Months
Creatinine
Urinalysis x2
Urine culture
Renal and bladder ultrasound
Hematuria Microscopic must be ≥3 RBC/HPF on at least two urinalysis prior to referral.
If patient had CT, ultrasound is not necessary.
Alternate name: Hematuria Microscopic (≥3 rbc/hpf)
Process: Send referral to Zone FAST Team.
< 6 Months
Creatinine
Urinalysis
Urine culture
Renal and bladder ultrasound
Process: Send referral to Zone FAST Team.
Non-obstructive kidney stone
< 3 Months
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Kidney Ureter Bladder (KUB) x-ray. Referrals missing KUB x-ray will not be accepted
Renal colic CT or abdominal ultrasound
If discrepancy between KUB x-ray and abdominal ultrasound, consider a CT scan.
Alternate name: Kidney Stone Non-Obstructive
Process: Review clinical pathway
Send referral to Zone FAST Team
Diagnosis of gender dysphoria as outlined in the Provincial Adult Gender Affirming Care Pathway
Orchidectomy (Gender Affirming)
Process:
< 6 Months
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Urine culture
Renal and bladder ultrasound
Alternate name: Overactive Bladder (OAB)
Process: Send referral to Zone FAST Team.
Persistent testicular pain
< 6 Months
Urinalysis
Urine culture
Scrotal ultrasound
Alternate name: Testicular Pain Chronic (non-STD)
For STD-related pain, refer to zonal STD clinic.
Process: Request non-urgent advice: Contact Lethbridge Urology Surgeons at 403-524-1411 or Dr. Talal Alphin (Medicine Hat) at 403-528-2912.
< 6 Months
Patient to bring picture of erection to appointment (within 30 days)
- AM total testosterone(to be completed within the hours of 0800-1000)
- Fasting glucose
- Lipids panel
Process: Send referral to Zone FAST Team.
< 6 Months
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Urine culture
Alternate name: Vaginal Prolapse (includes cystocele)
Process: Send referral to Zone FAST Team.
If mass originally found on Contrast Enhanced CT Abd/Pelvis: Urology to order further imaging (if required)
If mass originally identified on US: order Renal Mass Protocol CT
Alternate name: Renal Cyst (Simple, Asymptomatic)Renal Cyst (Complex or symptomatic simple)Access target: <2 weeks for urgent
Process:
- Refer to Clinical Pathway: Provincial Renal Mass Primary Care Pathway
- Complex is considered a Bosniak Category IIF (with symptoms), III or IV
- If Bosniak Category IIF with no symptoms. Follow Renal Mass Protocol CT/MRI q6-12 months for the first year and then yearly x 5 years. No consultation required.
- Send referral to North Zone FAST Team
< 4 Weeks
If mass originally found on Contrast Enhanced CT Abd/Pelvis: Urology to order further imaging (if required)
If mass originally identified on US: order Renal Mass Protocol CT
Alternate name: Renal Mass (suspicious for
malignancy)
Process:
< 1 Week
Alternate name: Testicular Mass
Process: Send referral to Zone FAST Team.
Testicular microlithiasis
< 6 Months
Process: Request non-urgent advice: Contact Lethbridge Urology Surgeons at 403-524-1411 or Dr. Talal Alphin (Medicine Hat) at 403-528-2912.
Other information: Refer only if patient has failed 3 different PDE 5 Inhibitors x 5 consecutive doses.
Alternate name: Undescended Testicle with Negative BHCQ and AFP
Process: If urgent, call RAAPID.
If non-urgent, send referral to Zone FAST Team.
Process: Request non-urgent advice: Contact Lethbridge Urology Surgeons at 403-524-1411 or Dr. Talal Alphin (Medicine Hat) at 403-528-2912.
Process: Jump to “Lower Urinary Tract Symptoms (LUTS)” on this page.
< 6 Months
Pelvic ultrasound with PVR
Referral letter should include description of pelvic exam findings
Urinalysis
Urine culture
Process: Review clinical pathway
Send referral to Zone FAST Team.
Urinary retention - acute
< 2 Weeks
- Creatinine
- Urinalysis
- Urine culture
Process: Send referral to Zone FAST Team.
< 6 Months
Evidence on urinalysis and cultures of 2 UTIs in 6 months or 3 UTIs in 12 months
- Creatinine
- Urinalysis
- Urine culture
- Renal and bladder ultrasound
- Include a copy of medications used for treatment
Urinary Tract Infection (UTI Recurrent)
Definition of recurrent UTI:
- 2 UTI’s in 6 months, or
- 3 UTIs in 12 months
Process:
< 6 Months
Process: Request non-urgent advice: Contact Lethbridge Urology Surgeons at 403-524-1411 or Dr. Talal Alphin (Medicine Hat) at 403-528-2912.
Other information: Must be symptomatic and clinically detectable on physical exam.
< 6 Months
Process: Send referral to Zone FAST Team.
< 6 Months
Alternate name: Vasectomy Reversal
Process: Send referral to Zone FAST Team.