Referral route 

GPs should book an appointment into one of the following services before the patient leave the practice: 

  • Bladder and renal 1, 2. 

  • Prostate 1

  • Testes and penile (outpatients only) 2 

1 - If your patient can undertake a telephone assessment, please book this for bladder and renal, and prostate services.  

2 - Patient should be available within 0-3 days.  

All the above services are NOT suitable for patients below the age of 16 years. 

We do not normally advise PSA testing on patients younger than 40 years. If you are considering this, please use Advice & Guidance.  

For patients older than 80 years, please only do PSA testing if life expectancy is greater than 10 years and where referral and treatment is in their best interests. Please consider patient’s preferences and co-morbidity. 

If patients have implantable cardiac devices, we cannot complete their MRI, so please refer to Barts Health USC/accelerated prostate clinics. 

Possible procedures on typical USC (“2ww”) pathway

  • Bladder and renal - KUB Ultrasound, CT IVU (some patients), urine tests, Flexible cystoscopy.
  • Prostate - Clinic will assess symptoms, need and suitability for prostate MRI and Transperineal Prostate biopsy, then fast-track Straight to Test.
  • Testes and penile - Ultrasound testes, CT (chest, abdomen, pelvis), blood test, urine tests .


Essential tests prior to referral
Bladder and renal.
Bloods - U/E, FBC, PSA (men over 50 years), MSU for microscopy and culture/sensitivity (if suspected UTI). 

Prostate
Patient needs to have PSA tests (as a base line) within the last 3 months. A marginally elevated PSA should be repeated before referral. Exclude urine infection as a cause for raised PSA. If UTI, treat with appropriate antibiotics and repeat PSA after at least 8 weeks to see if it has returned to normal. If PSA remains raised, then refer to USC (“2ww”) prostate pathway. USC referral if PSA is above Age-Related values. Please document the PSA Value on all patients before referring to our service. 

Testes and penile

  • Bloods: U/E, FBC, PSA (men over 50 years), alpha-fetoprotein, Beta-HCG, LDH.
  • Ultrasound 

Optional tests (concurrent to referral) or other useful information
No further tests required for bladder and renal, and prostate as the Urology service will book these in the one stop shop appointment. For testes and penile investigations, it would be helpful if the GP could book an ultrasound to help rule out benign lumps. However, this must be urgent, timed and close to the appointment slot. 

Things the hospital or patient need to know
Patient is available to attend appointments over following 6 weeks after initial referral. (if on holiday, please refer after return).

  • Bladder and renal - any pervious contrast allergies, contraindications for MRI (e.g. aneurism clips, metal implants, valves etc)
  • Prostate - Contraindications to MRI. Please detail clearly on your referral, if the patient has metalwork, hip replacements or claustrophobia. If patient has a pacemaker, please refer to Barts Health 2WW service. 

What the hospital tells the patient in letters 

Female Patients (bladder and renal): 

Phone appointment

We will try our best to call you on time. Please allow one hour from your appointment time for this call. Keep your phone free and nearby you during this time. Do make sure your phone can receive calls from private or withheld numbers. (You can check this with your telephone provider). Try to stay in a quiet place during the call. You will be called by either a Clinical Nurse Specialist or consultant. They will ask you questions about your symptoms. They may arrange for some tests to be done. If so, they will talk to you about these tests in the phone call.  

Outpatient appointment  

We try hard to minimise delays in clinic. Please allow up to 2 hours for your appointment. You may be asked to have a radiology scan before your appointment. If so, our radiology department will get in touch with the details.  

Male patients (bladder, renal, prostate, testes and penile) 

Telephone Appointments

We will try our best to call you on time. Please allow one hour from your appointment time for this call. Keep your phone free and nearby you during this time. Do make sure your phone can receive calls from private or withheld numbers. (You can check this with your telephone provider). Try to stay in a quiet place during the call. You may be asked to have a scan before your appointment. If so, someone from our radiology department will get in touch to give you the details. If your GP asked for you to have a Prostate Specific Antigen (PSA) test, please do this before your appointment.  

Outpatient appointments  

We try hard to minimise delays in clinic. Please allow up to 2 hours for your appointment. You may be asked to have a radiology scan before your appointment. If so, our radiology department will get in touch with the details. If your GP asked for you to have a Prostate Specific Antigen (PSA) test, please do this before your appointment. At your appointment, you may have a physical examination. If your prostate is being checked, this may include a rectal examination.