What is the approach for a new patient urology consult?

New Patient Urology Consult Template

A comprehensive urology consult should follow a structured approach that includes detailed history, focused physical examination, appropriate diagnostic testing, and clear documentation of findings and recommendations to ensure optimal patient outcomes.

Chief Complaint and History of Present Illness

• Document the primary reason for consultation (e.g., hematuria, lower urinary tract symptoms, elevated PSA, urinary retention, scrotal mass) 1, 2
• Record symptom onset, duration, severity, and exacerbating/alleviating factors 3
• Document relevant urinary symptoms:
  • Voiding symptoms: hesitancy, weak stream, intermittency, straining 1
  • Storage symptoms: frequency, urgency, nocturia 1
  • Post-micturition symptoms: feeling of incomplete emptying, post-void dribbling 1
  • Pain: suprapubic, flank, scrotal, penile 2
  • Hematuria: gross vs. microscopic, timing during urination, associated symptoms 2

Past Medical/Surgical History

• Document relevant medical conditions (diabetes, neurological disorders, cardiovascular disease) 4
• Previous urological procedures or surgeries 3
• History of urinary tract infections, stones, or malignancies 2
• Previous catheterizations or urodynamic studies 5

Medication History

• Current medications with special attention to:
  • Alpha-adrenergic agonists (can cause urinary retention) 4
  • Anticholinergics (can affect bladder function) 4
  • 5-alpha reductase inhibitors (affect PSA levels and prostate size) 1
  • Anticoagulants/antiplatelets (relevant for hematuria and surgical planning) 2

Family History

• Document family history of urological malignancies (prostate, bladder, kidney) 1
• Family history of urolithiasis 2

Social History

• Smoking history (risk factor for bladder cancer) 1
• Occupational exposures to chemicals 1
• Sexual history when relevant to presenting complaint 1
• Alcohol and caffeine intake 2

Review of Systems

• Constitutional symptoms: fever, weight loss, fatigue 2
• Gastrointestinal: constipation, diarrhea (can affect urinary symptoms) 2
• Neurological: weakness, sensory changes, back pain 4
• Cardiovascular: edema, orthopnea 2
• Endocrine: polydipsia, polyuria 2

Physical Examination

• Vital signs including blood pressure 6
• Abdominal examination: palpation for masses, suprapubic tenderness, costovertebral angle tenderness 6
• Male genitourinary examination:
  • Penis: phimosis, lesions, discharge 1
  • Scrotum: masses, tenderness, hydrocele, varicocele 2
  • Digital rectal examination: prostate size, consistency, nodules, tenderness 1
• Female genitourinary examination when indicated:
  • External genitalia: atrophy, lesions 1
  • Pelvic examination: prolapse, masses 2
• Neurological examination: perineal sensation, anal tone, lower extremity reflexes 4

Diagnostic Testing

• Urinalysis with microscopy (hematuria, pyuria, bacteriuria, crystals) 6
• Urine culture if infection suspected 4
• Serum studies as indicated:
  • PSA for prostate cancer screening/monitoring 1
  • Creatinine/BUN for renal function 2
  • Electrolytes if obstruction or retention suspected 4
• Post-void residual measurement for suspected retention (>300 mL on two occasions at least six months apart defines chronic urinary retention) 4
• Additional imaging as indicated by presentation:
  • Renal/bladder ultrasound 6
  • CT urogram for hematuria workup 2
  • Transrectal ultrasound for prostate evaluation 1

Assessment

• Primary diagnosis or differential diagnoses 2
• Risk stratification for conditions like prostate cancer using established criteria 1
• Severity assessment of conditions like BPH using validated tools (IPSS) 1

Plan

• Immediate interventions (e.g., catheterization for retention) 5
• Diagnostic plan: additional testing needed 2
• Treatment recommendations:
  • Medical therapy (specific medications with dosing) 1
  • Surgical options when indicated 1
  • Lifestyle modifications 2
• Follow-up timing and parameters 2
• Indications for urgent return or emergency care 1

Telehealth Considerations (if applicable)

• For video visits, ensure proper environment and privacy 1
• Guide patient through self-examination when appropriate 1
• Document limitations of virtual assessment 1
• Arrange for necessary in-person testing separately 1

Documentation of Patient Education

• Document discussion of diagnosis, treatment options, risks/benefits 1
• Note patient preferences and shared decision-making process 1
• Document information provided about condition and expected outcomes 1

Referrals and Consultations

• Subspecialty urology referrals if needed (oncology, female urology, etc.) 1
• Multidisciplinary referrals when appropriate (radiation oncology, medical oncology) 1

By following this structured template, urologists can ensure comprehensive evaluation of new patients while documenting all pertinent information needed for diagnosis and management planning.