When to Refer Guide
DIAGNOSIS |
REFERRAL |
Non-communicating Hydrocele |
One year of age or symptomatic |
Communicating Hydrocele/Hernia |
At diagnosis |
Hypospadias |
3–6 months of age (surgery at 6–18 months of age) |
Undescended Testis |
6 months of age (surgery at 12 months of age) |
Circumcision – Newborn |
Up to 2 months of age, if parental preference and covered by insurer |
Circumcision |
Balanitis, UTI, non-physiologic phimosis, if parental preference and covered by insurer |
UTI |
Any febrile UTI (US and VCUG); Any UTI in males; Recurrent UTIs in females |
Prenatal Hydronephrosis |
As soon as reasonably possible (newborn renal ultrasound with repeat at one month of age) |
Vesicoureteral Reflux |
At time of diagnosis, at time of repeat imaging, and with any change in clinical course (UTIs) |
Daytime Incontinence |
If failing behavioral therapy and management of constipation |
Enuresis |
If failing behavioral therapy (age < 6) and/or DDAVP (age > 6) |
Spina Bifida or Neurogenic Bladder |
At least annually though anytime symptoms arise (worsening incontinence, symptomatic UTIs) |
Microscopic Hematuria |
Confirmed by microscopy and no concurrent infection |
Labial Adhesions |
If symptomatic (dribbling, UTI, vulvovaginitis) |
Meatal Stenosis |
If symptomatic (spraying, pain, UTI) |
Other Pathology |
Any time it produces concern |
URGENT / EMERGENT PATHOLOGY: Urolithiasis, Tumors (testicular, renal), Obstruction (UPJ, UVJ, ureteroceles), Ambiguous genitalia, Scrotal findings concerning for torsion, Posterior urethral valves, prune belly syndrome, Bladder exstrophy |