What mnemonic skills are best for a urologic provider?

Effective Mnemonics for Urologic Providers

The most clinically validated mnemonic for urologic practice is the systematic approach to hematuria evaluation using risk stratification criteria, while general ICU-based mnemonics like FASTHUG-MAIDENS have proven utility for medication-related assessments but lack urology-specific validation.

Hematuria Evaluation Mnemonic: The "3-R" Approach

The most evidence-based systematic approach for urologic providers involves Risk stratification, Rule-out benign causes, and Repeat confirmation 1, 2:

Risk Stratification Framework

High-Risk Criteria (requires immediate cystoscopy and imaging) 1:

• Age ≥60 years
• Smoking history >30 pack-years

• 25 RBC/HPF on urinalysis

• History of gross hematuria
• Occupational exposure to benzenes or aromatic amines

Intermediate-Risk Criteria (shared decision-making for cystoscopy) 1:

• Women age 50-59 or men age 40-59 years
• 10-30 pack-years smoking history
• 11-25 RBC/HPF on single urinalysis

Low-Risk Criteria (may defer immediate invasive evaluation) 1:

• Women <50 years or men <40 years
• Never smoker or <10 pack-years
• 3-10 RBC/HPF on single urinalysis

Rule-Out Benign Causes Systematically

The "MIST" approach for benign hematuria causes 1:

• Menstruation - repeat UA 48 hours after cessation
• Infection - obtain urine culture, treat, repeat UA at 6 weeks
• Sexual activity/trauma - consider as transient cause
• Trauma/exercise - repeat UA 48 hours after cessation

Repeat Confirmation Protocol

Critical timing for follow-up 1, 2:

• Post-UTI treatment: repeat UA at 6 weeks (not earlier - this is a critical safety checkpoint as ~3% harbor malignancy)
• Persistent hematuria after negative workup: repeat UA at 6,12,24, and 36 months
• Comprehensive re-evaluation at 3-5 years if hematuria persists

Catheter-Associated Hematuria: The "DRIP" Mnemonic

For managing catheter-related bleeding 2:

Drainage assessment - ensure catheter patency, consider replacement with appropriate size (14-16 Fr) 2

Rule out trauma - assess for urethral injury signs (blood at meatus, difficult passage, perineal ecchymosis); perform retrograde urethrography before re-attempting if suspected 2

Infection evaluation - obtain urine culture before antibiotics; catheter-associated UTI is the fourth leading cause of hospital-acquired infections 2

Pelvic trauma consideration - if gross hematuria with pelvic fracture, 29% have bladder rupture requiring retrograde cystography 2

Overactive Bladder Assessment: The "DIAPER" Framework

Based on AUA/SUFU guidelines for systematic OAB evaluation 3:

Duration and baseline symptoms - document timeline and severity 3

Indications review - assess current medications that may cause symptoms 3

Abdominal and pelvic exam - include rectal/GU exam and lower extremity edema assessment 3

Post-void residual - measure in patients with obstructive symptoms, neurologic diagnoses, or history of surgery (use caution with antimuscarinics if PVR 250-300 mL) 3

Exclude other conditions - perform urinalysis to rule out UTI and hematuria; refer if hematuria present 3

Review cognitive function - assess ability to dress independently as indicator of toileting capability 3

Antimicrobial Prophylaxis: The "STOP" Principle

From AUA Best Practice Statement 3:

Single-dose only - AP recommended for most urologic cases, not beyond case completion 3

Timing critical - ensure minimum inhibitory concentrations at procedure time; may require re-dosing for long cases 3

Organism-directed - select antimicrobial based on surgical site and likely pathogens 3

Prevent resistance - use lowest effective dose; systemic antimicrobial usage is primary driver of resistance 3

Urologic Infection Management: The "CATS" Approach

Based on EAU guidelines 3:

Culture before treatment - perform validated NAAT on first-void urine or urethral smear for urethritis; urethral swab culture for gonorrhea resistance profiling 3

Assess for sepsis - use SOFA or qSOFA scoring; obtain two sets of blood cultures and drainage fluids 3

Treat pathogen-directed - use local resistance data; sexual partners require treatment 3

Source control - relieve obstruction and drain abscesses in urosepsis; collaborative care with ICU and infectious disease 3

Common Pitfalls to Avoid

Never attribute hematuria solely to anticoagulation - evaluate identically regardless of anticoagulation status 1, 2

Never delay post-UTI follow-up - the 6-week repeat UA is mandatory, not optional, as delayed cancer diagnosis can occur 1

Never perform inadequate cystography - clamping Foley and allowing IV contrast accumulation misses bladder injuries 2

Never use prophylactic antimicrobials routinely - do not use to prevent catheter-associated UTI or after catheter removal 3

Never extend antimicrobial prophylaxis beyond case completion - single-dose is sufficient for most procedures 3