تجمع حفر الباطن الصحي
Urology
Urinary Tract Infections
Routine — روتيني
- Recurrent UTI: ≥2/6 months or ≥3/year (esp. non-menopausal women or unrelated to sexual activity).
- Suspected structural/functional abnormalities (post-void residuals, neurogenic bladder, diverticulum, fistula).
- Persistent hematuria after UTI treatment.
- Men with ≥2 UTIs — BPH, prostatitis, structural workup.
Urgent (<5 days) — عاجل (< 5 أيام)
- UTI in pregnancy with persistent symptoms or pyelonephritis signs.
- Pyelonephritis not improving within 48–72h of oral antibiotics.
- Complicated UTI (diabetes, catheter, immunosuppressed) with poor response.
- UTI in child <3 years or with unusual features.
Immediate (ER referral) — فوري (طوارئ)
- Sepsis or hemodynamic instability.
- Obstructive uropathy with infection (hydronephrosis, flank pain + AKI).
- Pyelonephritis with vomiting/dehydration.
- Suspected perinephric abscess in unwell patient.
Benign Prostate Hyperplasia
Routine — روتيني
- Moderate-severe LUTS not improving with medical therapy after 6–12 weeks.
- Recurrent UTIs from suspected outlet obstruction.
- Bladder stones or significant post-void residuals on US.
- Unexplained gross hematuria after negative workup.
- Consideration of surgical options (TURP, minimally invasive).
Urgent (<5 days) — عاجل (< 5 أيام)
- Refractory urinary retention after failed voiding trial.
- Elevated PSA with abnormal DRE (asymmetry, nodularity).
- Rapidly worsening symptoms or suspicion of other pathology.
Immediate (ER referral) — فوري (طوارئ)
- Acute urinary retention — requires catheterization.
- Obstructive uropathy with renal impairment.
- Severe hematuria with clots causing outlet obstruction.
Elevated PSA
Routine — روتيني
- Persistent PSA > age-specific threshold: 40–49 ≥2.5 · 50–59 ≥3.5 · 60–69 ≥4.5 · ≥70 ≥6.5 ng/mL.
- PSA rising ≥0.75 ng/mL/year on repeat testing.
- PSA elevated despite repeat after 6–8 weeks.
Urgent (<5 days) — عاجل (< 5 أيام)
- Any abnormal DRE and/or red flags (bone pain, weight loss) regardless of PSA.
- Any PSA ≥10 ng/mL.
- Rapidly rising PSA (doubling in <12 months).
Delay PSA testing for 6–8 weeks after UTI, catheterization, ejaculation, or DRE. Always repeat PSA before referral if first result was mildly elevated and no red flags are present.
Erectile Dysfunction
Routine — روتيني
- Lack of response to first-line therapy (lifestyle + max-tolerated PDE5 inhibitor).
- Hormonal abnormalities (low T with symptoms, low LH/FSH) → endocrinology.
- Significant psychological contributors → mental health referral.
Urgent (<5 days) — عاجل (< 5 أيام)
- Peyronie's disease or penile deformity causing painful/impaired intercourse.
Immediate (ER referral) — فوري (طوارئ)
- Priapism >4 hours.
- Traumatic penile injury (fracture, hematoma).
- Acute urinary retention post-intervention.
Sexually Transmitted Infections (STIs)
Routine — روتيني
- Recurrent/chronic urethritis despite proper treatment.
- Suspected urethral stricture post-STI (weak stream, high PVR).
- Penile warts/genital lesions needing excision.
- Chronic/recurrent balanitis/posthitis with HPV, HSV, hygiene concerns.
- Post-STI erectile or ejaculatory dysfunction.
Urgent (<5 days) — عاجل (< 5 أيام)
- Proctitis or epididymitis with systemic symptoms or MSM → rule out co-infections (LGV, gonorrhea, chlamydia, HIV).
Renal & Ureteric Stones
Routine — روتيني
- Stone not passed after 4–6 weeks despite medical expulsive therapy.
- Asymptomatic renal stone >1 cm for elective intervention.
- Persistent microscopic hematuria with confirmed stone.
- Pregnant patient with stable asymptomatic stone (after OB coordination).
Urgent (<5 days) — عاجل (< 5 أيام)
- Pain uncontrolled despite optimal analgesia.
- Hydronephrosis on US without systemic signs.
- Gross hematuria or recurrent clot passage.
- Known stone with recurrent ED visits.
Immediate (ER referral) — فوري (طوارئ)
- First episode: send to ER for pain management and diagnostic confirmation.
- Obstructive stone + infection signs (fever, leukocytosis) — urosepsis risk.
- Solitary kidney with ureteric stone.
- Anuria or rising creatinine.
- Intractable vomiting/dehydration.
- Pregnant with obstruction + systemic signs.
Metabolic stone evaluation goes to Internal Medicine. MET: Tamsulosin 0.4 mg daily ×4 weeks for distal ureteric stones <10 mm. Avoid NSAIDs if renal impairment suspected.
Hematuria
Routine — روتيني
- Persistent microscopic hematuria after negative culture, no menses/trauma, repeated ≥2× — esp. age ≥35, male, smoker, occupational exposure.
- Gross hematuria resolved without red flags.
- Microscopic hematuria with urothelial cancer risk factors.
Urgent (<5 days) — عاجل (< 5 أيام)
- Recurrent gross hematuria without pain/infection.
- Visible blood + age >50 with no infection or trauma.
- Microscopic hematuria with elevated PSA or abnormal DRE.
Immediate (ER referral) — فوري (طوارئ)
- Gross hematuria with clot retention or inability to void.
- Visible hematuria with signs of acute anemia or hypotension.
- Hematuria + flank pain, fever, or suspected pyelonephritis with instability.
Testicular Pain & Masses
Routine — روتيني
- Stable hydrocele/varicocele (cosmetic, infertility, discomfort).
- Recurrent epididymitis (≥2/12 months) despite adequate antibiotics.
- Small, stable epididymal cysts.
- Suspected spermatocele in stable patient.
- Post-infectious scrotal swelling after resolution.
- Recurrent testicular discomfort impacting daily life.
Urgent (<5 days) — عاجل (< 5 أيام)
- New painless testicular mass in adolescents/adults.
- Testicular pain >1 week despite antibiotics/NSAIDs.
- Persistent induration after treated epididymo-orchitis.
- Unresolving hydrocele/varicocele with infertility.
- Epididymitis in male <35 — consider STI; refer if recurrent or atypical.
Immediate (ER referral) — فوري (طوارئ)
- Suspected testicular torsion — refer within <6 hours.
- Severe acute scrotal pain without clear cause.
- Scrotal trauma with hematoma, rupture, swelling.
- Epididymo-orchitis + systemic signs.
- Painful swelling + inability to urinate.