When to Refer Guide



Non-communicating Hydrocele

One year of age or symptomatic

Communicating Hydrocele/Hernia

At diagnosis


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


Balanitis, UTI, non-physiologic phimosis, if parental preference and covered by insurer


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


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