< 4 Weeks
Alternate name: Abnormal DRE (new diagnosis)
Process: Send referral to Calgary Zone FAST Team.
< 4 Weeks
Electrolyte panel (Sodium, Chloride, Potassium and Bicarbonate)-note if using paper requisition please write “electrolyte panel”
Creatinine, random glucose, cortisol, 24-hour urine metanephrines
CT or MRI abdomen
Alternate name: Adrenal Mass
Access Targets:- <4 weeks: <4cm size
- <2 weeks: >4cm size (urgent)
Process: Send referral to Calgary Zone FAST Team.
Confirm with contrast enhanced CT/MRI
Process:- Angiomyolipoma (<4cm) - Ask for Advice by calling Specialist Link
- Angiomyolipoma (>4cm) - Send referral to Calgary Zone FAST Team
Process: Request non-urgent advice: Call Specialist Link.
< 1 Month
Alternate name: Bladder Fistula (documented)
Process: Send referral to Zone FAST Team.
< 3 Months
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Kidney Ureter Bladder (KUB) x-ray. Referrals missing KUB x-ray will not be accepted
Renal colic CT or abdominal ultrasound
If discrepancy between KUB x-ray and abdominal ultrasound, consider a CT scan.
Alternate name: Kidney Stone Non-Obstructive
Process: Review clinical pathway
Send referral to Zone FAST Team
< 6 Months
Scrotal ultrasound (must include measured dimensions of cyst)
Alternate name: Epididymal Cyst
Symptomatic > 1 cm, spermatocele.
Process: Send referral to Zone FAST Team.
< 6 Weeks
Alternate name: Urethral Disorder (female)
Process: Send referral to Zone FAST Team.
< 6 Months
Urinalysis
Urine culture
Renal bladder ultrasound (no x-ray needed)
Alternate name: Female Voiding Dysfunction
Process: Send referral to Zone FAST Team.
Elevated PSA with no previous prostate cancer
< 4 Weeks
Urinalysis
Urine culture (if urinalysis abnormal)
Prostate-specific antigen (PSA), 2 tests done at least 4 weeks apart.
Alternate name: Elevated PSA (no previous prostate cancer)
Process: DRE recommended. Review clinical pathway
Send referral to Zone FAST Team
Elevated PSA with previous prostate cancer
< 4 Weeks
Urinalysis
Urine culture (if urinalysis abnormal)
Prostate-specific antigen (PSA), 2 tests done at least 4 weeks apart.
Alternate name: Elevated PSA (previous prostate cancer)
Process: DRE recommended. Review clinical pathway
Send referral to Zone FAST Team
< 6 Months
Process: Send referral to Zone FAST Team.
Other information:- Refer only if patient has failed 2 different PDE 5 Inhibitors x 5 Consecutive Doses (each) or additional trials could not be completed.
- Confirm patient interest in penile injection therapy or surgery prior to referral.
Female urinary-genital tract fistula
< 3 Months
Alternate name: Fistula - Female Urinary Genital Tract
Process: Send referral to Zone FAST Team.
< 3 Months
Alternate name: Foreskin Problems (includes Phimosis)
Process: Send referral to Zone FAST Team.
Other information: Patient must have failed a two-month trial of a steroid cream prior to referral.
< 6 Months
Urinalysis
Urine culture
PSA, if between age 40-75
Abdominal and pelvic ultrasound
Process: Request non-urgent advice: Call Specialist Link.
< 4 Weeks
CT Urogram - with indication of “gross hematuria, urologyconsult pending.”
Creatinine
Alternate name: Hematuria Gross
Process: Send referral to Zone FAST Team.
- Do Not Delay Urology Referral for CT results.
- The referral to urology and for CT should made concurrently.
- Ultrasound and Urine CYTOLOGY is not indicated and will be performed by urology as required.
< 3 Months
Creatinine, urinalysis x 2 (approx.1 month apart)
Renal and bladder ultrasound: - If patient has had a CT, an ultrasound is not necessary
Hematuria Microscopic must be greater than or equal to 3 RBC/HPF on at least two urinalysis prior to referral.
Alternate name: Hematuria Microscopic (≥3 rbc/hpf)
Process: Send referral to Zone FAST Team.
CLINICAL PATHWAY: PROVINCIAL HEMATURIA EVALUATION and follow risk stratification
Urine CYTOLOGY is not indicated and will be performed by urology as required.
< 6 Months
Scrotal ultrasound (must include dimensions of hydrocele)
Alternate name: Hydrocele
Process: Send referral to Zone FAST Team.
Other information: Must be symptomatic and clinically detectable on exam.
< 4 Weeks
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Renal and bladder ultrasound
If patient had CT, ultrasound is not necessary.
Process: Send referral to Zone FAST Team.
Process: Send referral to Zone FAST Team
< 6 Months
AM testosterone, fasting glucose, lipids panel
Patient MUST bring photo of erection to appointment
Alternate name: Peyronie's Disease
Process: Send referral to Zone FAST Team
< 2 Weeks
Electrolyte panel (Sodium, Chloride, Potassium andBicarbonate)- note if using paper requisition please write“electrolyte panel”
Calcium, creatinine, urinalysis
Kidney Ureter Bladder (KUB) x-ray. Referrals missing KUB x-ray will not be accepted
Kidney Ureter Bladder (KUB) x-ray and renal colic CT or KUBx-ray and abdominal ultrasound
Alternate name: Kidney Stone (Acute/Uteretic)
Process: Send referral to Zone FAST Team.
- Must have KUB x-ray - Referrals with ultrasounds only will not be accepted.
- If there is a discrepancy between the ultrasound and KUB x-ray, please consider a CT scan
Lower urinary tract symptoms
< 6 Months
Urinalysis
Renal and bladder ultrasound
Alternate name: Lower Urinary Tract Symptoms (male LUTS)
Access Target: < 2 weeks for urgent
Process: Send referral to Zone FAST Team.
Other information: Includes BPH, urethral strictures, prostatitis, male chronic pelvic pain. For BPH, patient must have failed a one-month trial of tamsulosin (Flomax) prior to referral.
< 3 Months
Semen analysis
FSH
AM testosterone (to be completed within the hours of 0800-1000)
LH
Prolactin
Estradiol
Process: Send referral to Zone FAST Team.
< 6 Months
Alternate name: Male Sexual Dysfunction
Includes low testosterone, hypogonadism, ejaculatory dysfunction, rapid ejaculation
Process: Request non-urgent advice: Call Specialist Link.
< 2 Weeks
CBC and INR
Abdominal/pelvis CT with contrast
Alternate name: Penile Mass (cancer concern)
Process: Send referral to Zone FAST Team.
< 1 Week
Alternate name: Testicular Mass
Process: Send referral to Zone FAST Team.
< 2 Weeks
Alternate name: Bladder Mass
Process: Send referral to Zone FAST Team.
< 6 Months
Creatinine
Urinalysis
Urine culture
Renal and bladder ultrasound
Process: Send referral to Zone FAST Team
Diagnosis of gender dysphoria by a specialist in transgendercare
ORCHIDECTOMY (GENDER AFFIRMING)
Process: Send referral to Calgary Zone FAST Team
Please note, referrals will only be accepted from specialty transgender clinics/practices.
< 6 Months
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Urine culture
Renal and bladder ultrasound
Alternate name: Overactive Bladder (OAB)
Process: Send referral to Zone FAST Team.
Persistent testicular pain
< 6 Months
Urinalysis
Urine culture
Scrotal ultrasound
Alternate name: Testicular Pain Chronic (non-STD)
For STD-related pain, refer to zonal STD clinic.
Process: Request non-urgent advice: Call Specialist Link.
< 3 Months
Simple renal cysts do not require consultation or further imaging.
If mass originally identified on US: order Renal Mass ProtocolCT
If mass originally found on Contrast Enhanced CT Abd/Pelvis:Urology to order further imaging (if required)
Alternate name:- Renal Cyst (Simple, Asymptomatic)
- Refer to CLINICAL PATHWAY: Provincial Renal Mass Primary Care Pathway
- Simple renal cysts that are asymptomatic (Bosniak
score I or II) do not require consultation or further imaging
- Renal Cyst (Complex or symptomatic simple)
- Refer to CLINICAL PATHWAY: Provincial Renal Mass Primary Care Pathway
- Complex is considered a Bosniak Category IIF (with symptoms), III or IV.
- If Bosniak Category IIF with no symptoms. Follow Renal Mass Protocol CT/MRI q6-12 months for the first year and then yearly x 5 years. No consultation required.
Access Target: < 2 weeks for urgent
Process: Send referral to Zone FAST Team.
< 2 Weeks
If mass originally found on Contrast Enhanced CT Abd/Pelvis:Urology to order further imaging (if required)
If mass originally identified on US: order Renal Mass ProtocolCT
Alternate name: Renal Mass (suspicious for malignancy)
Process: Send referral to Zone FAST Team
- Refer to CLINICAL PATHWAY: Provincial Renal Mass Primary Care Pathway
< 6 Months
Alternate name: Vasectomy Reversal
Process: Send referral to Zone FAST Team.
Testicular microlithiasis
< 6 Months
Process: Request non-urgent advice: Call Specialist Link.
Other information: Refer only if patient has failed 3 different PDE 5 Inhibitors x 5 consecutive doses.
Alternate name: Undescended Testicle with Negative BHCQ and AFP
Process: If urgent, call RAAPID.
If non-urgent, send referral to Zone FAST Team.
Process: Request non-urgent advice: Call Specialist Link.
Process: Jump to “Lower Urinary Tract Symptoms (LUTS)” on this page.
< 3 Months
Alternate name: Bladder Stone
Process: Send referral to Zone FAST Team.
< 6 Months
Pelvic ultrasound (needs to include bladder with PVR)
Referral letter should include description of pelvic exam findings
Urinalysis, urine culture, creatinine
Urinary retention - acute
< 2 Weeks
Electrolytes (sodium, chloride, potassium, bicarbonate) and creatinine
Urinalysis
Urine culture
Alternate name: Urinary Retention Acute (with indwelling catheter)
Process: Send referral to Zone FAST Team.
Urinary tract infectious disease
< 6 Months
Creatinine
Urinalysis
Urine culture
Medications used for treatment.
Alternate name: Recurrent Urinary Tract Infections (UTI)
Process: Review clinical pathway
Send referral to Zone FAST Team.
< 6 Months
Creatinine, urinalysis, urine culture
Alternate name: Vaginal Prolapse (includes cystocele)
Process: Send referral to Zone FAST Team.
< 6 Months
Process: Request non-urgent advice: Call Specialist Link.
Other information: Must be symptomatic and clinically detectable on physical exam.
< 6 Months
Process: Send referral to Zone FAST Team.