Kaiser WLA

Urology

Painless Hematuria
- CT urogram: In ED if active painless bleeding AND only if pt has gross hematuria, sig drop Hct, or anemic from bleeding. - if not active bleeding -> outpatient CT urogram & outpt urology referral

1. Our standard foley catheters are 16 F coudet catheters
2. If the patient has a prior stricture, surgery, TURP then do not keep attempting to place a larger catheter. This will just cause trauma and bleeding. Call urology
3. In the case of BPH a LARGER catheter may pass more easily
4. In gross hematuria, please use a 20 F three way catheter for irrigation. The hand irrigation portion is the most effective way of getting the clots out.
5. For ruling out kidney stones, a CT KUB is the study of choice
6. For painless gross hematuria, please order a CT urogram. A noncontrast study and contrast study will be performed.
7. Uric acid stones cannot be seen on a KUB but can be seen on a CT
8. Urology really does want the stone for analysis. Keep giving the urine strainers to the discharged patients
9. Tamulosin is the preferred agent for helping the patient pass stones. If they are already on hytrin then just keep them on it.
10. If a patient is post op, please do NOT have the RN's automatically place a foley in triage. This may be contraindicated after certain surgeries
11. Please order urine cultures when diagnosing recurrent UTI's. Many times it is not a UTI and the culture helps them when seeing the patient in clinic.
12. Please DO NOT tell patients to go to urology clinic without an appointment. Send a referral or direct book the patient. Later the same day or the next day may be too soon. For example, a kidney stone patient should be seen in 2-3 days to allow time for the stone to pass. They won't change management if seen later the same day or the next day.