Department of Urology Clinical Consult

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Common urology conditions and when to refer

Patients with urological dilemmas often present with symptoms while under the care of a first-line provider, such as a primary care or emergency department physician. While daytime and nighttime incontinence are common urological conditionsaffecting over five million U.S. childrenfrequent urinary tract infections (UTIs), fever, pain or discomfort can indicate an underlying urological condition.

Whether a patient is experiencing bouts of incontinence, bedwetting or UTIs, or presenting signs of more complex conditions (e.g., hydronephrosis, vesicoureteral reflux (VUR), blockages in the urinary tract and other conditions requiring surgery), there are many benefits to referring a patient to a urology specialist.

Clear (or unclear) factors 

According to Boston Children's urologist Caleb Nelson, MD, MPH, a specialist could be called upon for two distinct reasons:

  • A definitive diagnosis has been established, and the condition requires specialized care.
  • The nature of the illness is unknown.

Sometimes when a patient is referred to a specialist, it is because the patient has a condition where the indication for surgery is clear, such as a non-palpable testicle or hypospadias, for example, says Nelson, co-director of Boston Childrens Kidney Stone Program, the Urology Department's director of quality and safety, and co-director of Boston Childrens upcoming conference, Essential Pediatric Urology for the Primary Care Clinician. 

In other cases, the patient has symptoms or exam findings suggestive of a urological condition that the pediatrician may feel uncomfortable diagnosing or managing, or simply wants some additional input from the specialist, he adds

Providing peace of mind 

Most often, patients do not require surgery, Nelson notes, and hearing from a specialist that surgical treatment is not required gives the families peace of mind. We can often put their minds at ease. And if the patient does need surgery, we can help.

Testing and diagnosis

In addition to blood tests and urinalysis, urology specialists administer condition-specific diagnostic tests, including renal ultrasound, voiding cystourethrogram, radionuclide cystogram, DMSA renal scan or urodynamics, which detect the presence of more complex conditions, such as VUR and hydronephrosis.

To refer a patient for an evaluation with a Boston Childrens pediatric urologist, or to speak with our clinician staff, please call 800-704-8237. Press option 1. 

Clinician resource: Voiding improvement checklist 

To help you begin a conversation about daytime and nighttime incontinence, recurrent urinary tract infections and other urological conditions, Boston Children's Hospital's Voiding Improvement Program has prepared a checklist of questions (pictured above) that you may choose to use when discussing urological conditions with parents and patients.

These questions also may help you determine if there are underlying conditions that may indicate a more serious problem.

The checklist is available here.

Continue the conversation 

Boston Childrens Urology Department is continuing the conversation at the Essential Pediatric Urology for the Primary Care Clinician on Nov. 7 and 8 at the Omni Parker House in Boston. This CME will cover a wide range of common urological disease entities and will focus on practical, hands-on approaches to managing these conditions within a busy pediatric practice.

Boston Childrens urology experts will present evidence-based, state-of-the-art interactive presentations and highlight the initial assessment and treatment of pediatric urological disease, "tricks of the trade," and when to refer. The course is designed to assist the learners in changing their competence and performance in practice.

Learn more about pediatric urologic conditions and register for Essential Pediatric Urology for the Primary Care Clinician. 

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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