Urology referral criteria
Urology referral criteria – Adult
Emergency urology referrals
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region.
- Acute, painful urinary retention
- Acute paraphimosis (if unable to reduce in primary care)
- Acute renal or ureteric colic with obstruction and/or infection
- Acute scrotal pain only with suspicion of torsion
- Proven obstructing ureteric stone in patient with single kidney or kidney transplant
- Severe scrotal infection concerning for Fournier’s gangrene
- Severe urinary tract bleeding resulting in clot retention and/or symptomatic anaemia
- Torsion of the testes
- Unexplained acute onset urinary incontinence suspected as part of acute, or acute-on-chronic urinary retention (Patient in discomfort/pain and unable to void)
- Visible haematuria following trauma
Immediate urology referrals
Immediate referrals (seen within 7 days) are not handled by the Central Referral Service (CRS).
Do not send immediate referrals via CRS – send referrals for patients requiring immediate review (within the next 7 days) directly to the relevant hospital.
Immediately contact the on-call registrar or service to arrange an immediate urology assessment for:
- Chronic urinary retention with deteriorating renal function or hydronephrosis.
- Confirmed renal malignancy
- Suspected or confirmed testicular tumour
- Very high PSA and confirmed malignancy
To contact the relevant service, please see
HealthPathways: Acute Urology Assessment.
| Adult urology conditions with Referral Access Criteria |
| Please note this is not an exhaustive list of all conditions for public adult urology outpatient services and does not exclude consideration for referral unless specifically stipulated in the RAC excluded section |
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Excluded urology services
Excluded Elective Procedures
The WA Elective Surgery Access and Waiting List Management Policy states that all elective procedures performed in the WA health system must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons.
| Excluded procedure |
Exceptional circumstance includes |
| Gender reassignment procedures |
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| Insertion/revision of artificial erection device |
- Patients using uridomes
- Spinal patients with neurological erectile dysfunction
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| Lengthening of penis (phalloplasty) |
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| Male circumcision |
- Phimosis
- Paraphimosis
- Balanitis
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| Penile procedures for sex transformation |
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| Procedures for cosmetic reasons |
- Significant functional impairment
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| Reversal of sterilisation |
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| Vaginoplasty |
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| Vulvoplasty/Labiaplasty |
- Functional labial hypertrophy causing persistent infections
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Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For all excluded procedure referrals, state clearly in the referral that request is for an excluded procedure and include the clinical exception reason as to why it should be considered.
The WA Elective Surgery Access and Waiting List Management Policy may be access via the WA Health Policy Frameworks page.
Referral to public urology outpatient services is not routinely accepted for the following conditions:
| Condition |
Details (where applicable) |
| Lower urinary tract symptoms |
Excluded condition for the following:
- Mild to moderate lower urinary tract symptoms i.e. International Prostate Symptom Score (I-PSS) score of 0-19 that have not been treated
- Symptoms that have adequately responded to medical management (e.g. 5α-reductase inhibitors such as Dutasteride or α 1a-adrenoreceptor antagonist such as Prazosin/Tamsulosin/Silodosin)
- See HealthPathways: Urology
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| Male infertility |
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| Moderate to severe organ prolapse (female) |
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| Penile discharge |
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| Primary erectile dysfunction |
Excluded condition unless the following features apply:
- Erectile dysfunction secondary to surgical intervention
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| Renal mass |
Excluded condition for the following:
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| Scrotal abnormalities |
Excluded condition for the following:
- Minimally symptomatic (i.e. not impairing quality of life)/asymptomatic epididymal cyst, hydrocele or varicocele identified through ultrasound
- See HealthPathways: Urology
|
| Urinary incontinence |
Excluded condition for the following:
- Patients who have not yet tried and failed conservative treatments. These may include tamsulosin/Duodart/anticholinergics, physiotherapy for Pelvic Floor Training Exercises (PFTE)
- See HealthPathways: Adult Urinary Incontinence
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Last reviewed: 08-06-2023
More information
Email: DOHSpecialistRAC@health.wa.gov.au