عيادات المسالك البولية
- Urinary tract infections
Urgent (<5 days) | Immediate (ER Referral) | |
Recurrent UTI: ≥2 infections in 6 months or ≥3 in 1 year (especially in non-menopausal women or if not linked to sexual activity). Consider evaluation for urologic abnormalities, incomplete bladder emptying, or prophylactic options. Suspected structural or functional urinary tract abnormalities, e.g.: Post-void residuals, neurogenic bladder, known diverticulum, or suspected fistula. Persistent hematuria after UTI treatment → rule out malignancy or stones. Men with ≥2 UTIs → needs urology assessment for BPH, prostatitis, or structural issues. | UTI in pregnant woman with: Persistent symptoms despite appropriate antibiotics. Signs of pyelonephritis (fever, flank pain). Pyelonephritis not improving within 48–72 hours of oral antibiotics. Complicated UTI (e.g., diabetes, catheter, immunosuppressed) with poor response to therapy. UTI in child <3 years or with unusual features (fever, poor feeding, failure to thrive). | Sepsis or hemodynamic instability (fever, hypotension, tachycardia). Signs of obstructive uropathy with infection → e.g., hydronephrosis, flank pain + AKI. Pyelonephritis with vomiting/dehydration or inability to take oral meds. Suspected perinephric abscess or renal involvement in unwell patients. |
- Benign prostate hyperplasia
Urgent (<5 days) | Immediate (ER Referral) | |
Moderate-to-severe LUTS (lower urinary tract symptoms) not improving with medical therapy (e.g., after 6–12 weeks of alpha-blockers ± 5-alpha-reductase inhibitors). Recurrent urinary tract infections due to suspected bladder outlet obstruction. Bladder stones or significant post-void residuals seen on ultrasound. Gross hematuria unexplained after negative workup (e.g., no infection or clear cause). Consideration of surgical options (TURP, minimally invasive therapies) due to symptom burden or patient preference. | Refractory urinary retention, especially after failed trial of voiding post-catheterization.
| Acute urinary retention (inability to void with pain and bladder distension) → requires catheterization and urgent evaluation. Signs of obstructive uropathy with renal impairment (e.g., rising creatinine, bilateral hydronephrosis). Severe hematuria with clots causing bladder outlet obstruction. |
- Elevated PSA:
Routine | Urgent (<5 days) |
Persistent PSA > age-specific threshold Age 40–49 → ≥2.5 ng/mL Age 50–59 → ≥3.5 ng/mL Age 60–69 → ≥4.5 ng/mL Age ≥70 → ≥6.5 ng/mL PSA rising ≥0.75 ng/mL/year on repeat testing PSA elevated despite repeating the test after 6–8 weeks (e.g., to rule out transient rise due to infection, DRE, ejaculation, catheter, etc.) | Any Abnormal DRE and/or red flags symptoms (e.g. bone pain, weight loss) regardless of PSA levels. Any PSA level ≥10 ng/mL Rapidly rising PSA (Doubling in <12 months) |
Delay PSA testing for 6–8 weeks after UTI, catheterization, ejaculation, or DRE Always repeat PSA before referral if first result was mildly elevated and no red flags are present | |
- Erectile dysfunction
Routine | Urgent (<5 days) | Immediate (ER referral) |
Lack of response to first-line therapy, despite appropriate trials of: Lifestyle changes (weight loss, exercise, reduced alcohol, smoking cessation). Oral PDE5 inhibitors (e.g., sildenafil, tadalafil) at maximum tolerated dose and proper timing. Hormonal abnormalities: Confirmed low testosterone with symptoms, or concern for pituitary disease (e.g., low LH/FSH). Significant psychological contributors (e.g., anxiety, performance issues, relationship factors) → consider mental health referral. | Peyronie’s disease or penile deformity causing painful or mechanically impaired intercourse. | Priapism (erection >4 hours not related to stimulation or after PDE5 inhibitor use). Traumatic penile injury (e.g., suspected fracture, hematoma). Acute urinary retention post-intervention (e.g., catheter-related complications in those treated for ED with injection therapy). |
- Sexually transmitted infections (STIs)
Routine | Urgent (<5 days) | Immediate (ER referral) |
Recurrent or chronic urethritis despite: Correct empirical or confirmed treatment for gonorrhea/chlamydia. No identified infection but persistent symptoms (rule out strictures, prostatitis, or non-infectious causes). Suspected urethral stricture post-STI (e.g., weak stream, post-void dribbling, high PVR). Penile warts or genital lesions (e.g., large condyloma acuminata or recurrent warts needing excision or surgical options). Chronic or recurrent balanitis/posthitis associated with HPV, HSV, or hygiene concerns unresponsive to conservative care. Post-STI erectile or ejaculatory dysfunction, especially after prostatitis or urethritis. | Proctitis or epididymitis with systemic symptoms or men who have sex with men (MSM) → rule out co-infections (LGV, gonorrhea, chlamydia, HIV). |
- Renal & Ureteric Stones
Routine | Urgent (<5 days) | Immediate (ER referral) |
Stone not passed after 4–6 weeks, despite medical expulsive therapy (MET) Asymptomatic renal stone >1 cm requiring evaluation for elective intervention Persistent microscopic hematuria with confirmed stone Follow-up after ER discharge for obstructive stone (if surgical review is needed) Pregnant patient with stable, asymptomatic stone (after OB coordination) | Pain uncontrolled despite optimal analgesia (e.g., NSAIDs ± opioid trial) Hydronephrosis on ultrasound without systemic signs Gross hematuria or recurrent clot passage Radiolucent stone suspected with ongoing symptoms Known stone with recurrent ED visits due to pain or complications | First episode: suspected cases are sent to ER for pain management and diagnostic confirmation Obstructive stone + signs of infection (e.g., fever, flank pain, leukocytosis) → risk of urosepsis Solitary kidney with ureteric stone (any size or symptoms) Anuria or rising creatinine due to suspected obstruction Intractable vomiting/dehydration needing IV fluids Suspected sepsis or systemic toxicity Pregnant with obstruction and systemic signs |
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- Hematuria
Routine | Urgent (<5 days) | Immediate (ER referral) |
Microscopic hematuria persistent after: Negative urine culture No menstruation or trauma Repeated ≥2 times over weeks Especially with age ≥35, male, smoker, or occupational exposure Gross hematuria that resolved and no other red flags Microscopic hematuria in patients with risk factors for urothelial cancer (e.g., smoking, age >50, male, chemical exposure) | Recurrent gross hematuria without pain or infection Visible blood + age >50 with no infection or trauma Microscopic hematuria with concurrent elevated PSA or abnormal DRE | Gross hematuria with clot retention or inability to void Visible hematuria with signs of acute anemia or hypotension Hematuria + flank pain, fever, or suspected pyelonephritis + instability |
Gross hematuria = visible blood in urine Microscopic hematuria = ≥3 RBCs/hpf on ≥2 properly collected urine samples (after ruling out infection, menses, trauma) | ||
- Testicular pain & masses
Routine | Urgent (<5 days) | Immediate (ER referral) |
Stable hydrocele or varicocele in adult male (cosmetic concern, infertility, or discomfort) Recurrent epididymitis (≥2 episodes in 12 months) despite adequate antibiotic treatment Small, stable epididymal cysts not causing pain or infertility Suspected spermatocele in stable patient Post-infectious scrotal swelling after resolution of acute infection Recurrent testicular discomfort impacting daily life | New, painless testicular mass in adolescents or adults (even if no systemic signs) Testicular pain lasting >1 week despite antibiotics or NSAIDs Persistent induration or swelling after treated epididymo-orchitis Unresolving hydrocele or varicocele with infertility or progressive size Epididymitis in male <35 years — consider STI and refer if recurrent or atypical | Suspected testicular torsion (acute scrotal pain, high-riding testicle, absent cremasteric reflex, N/V) — refer within <6 hours Severe acute scrotal pain without clear cause Scrotal trauma with hematoma, rupture, or swelling Epididymo-orchitis + systemic signs (e.g., fever, sepsis, severe tenderness) Painful swelling + inability to urinate or voiding retention |