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REMEDY : BNSSG referral pathways & Joint Formulary

Urology - 2WW

Checked: 30-09-2022 by vicky.ryan Next Review: 29-09-2023

Service Overview

Service provided by NBT at Southmead Hospital. The service is for patients who meet the local Urology Cancer Two Week Wait criteria (see section below).

The service offers consultation with diagnostics and onward referral for treatment as required.

At time of referral please issue the relevant BNSSG 2WW Patient Information Leaflet - COVID-19 edition, which is available in English and 14 additional languages.  There is also an Easy Read version of the leaflet.

Contact details ADULT 2WW:

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to cancerservices@nhs.net

Referral Guidance

Patients must meet the referral criteria as indicated on the Urology Cancer Referral Form (word doc).  Patients must be referred using this form. Please also take note of section below on 'Guidelines on making a 2WW referral'.

If advised to refer into MDT, then please submit a 2WW referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

Please also see the Prostate - PSA page for advice on PSA testing.

Prostate

  • Prostate feels malignant on digital rectal examination - features include asymmetry, irregularity, nodules and differences in texture e.g firm or hard. Please request PSA prior to referral

  • Elevated age specific PSA in men with 10 year life expectancy. PSA test should be postponed for at least 1 month after treatment of UTI.

  • Age specific PSA ranges (updated in line with NICE guidance NG12 - Dec 2021):

  • Below 40

    Use clinical judgement

    40 to 49

    More than 2.5

    50 to 59

    More than 3.5

    60 to 69

    More than 4.5

    70 to 79

    More than 6.5

    Above 79

    Use clinical judgement - see advice below

     

  • Raised PSA in men 80 years or older should be referred according to criteria below:

    • asymptomatic and abnormal PSA <20 , please discuss with urologist or use urology A and G service as referral may not be necessary
    • asymptomatic and PSA 20-50, urgent rather than 2WW referral
    • asymptomatic and PSA> 50 for 2WW referral
    • symptomatic (e.g bone pain and weight loss) and PSA 20 or over, for 2WW referral

 Testicular

  • Non-painful swelling or mass or change in shape of the body of the testis

For testicular/scrotal changes that are not concerning but where there is diagnostic uncertainty then refer for routine ultrasound.

Bladder & Renal

  • Unexplained visible haematuria  in adults without UTI - refers to patients where UTI and urinary  stone disease have been excluded.

  • Visible haematuria that persists or recurs after successful treatment of a UTI.

(Patients < 45 with unexplained visible haematuria may be referred urgently but outside 2WW system. Patients aged 45 years or over should be referred as 2WW.)

  • Non- visible haematuria in patients aged 60 or over with either dysuria or raised white cell count on a blood test.

(Patients with NVH outside of this group should be managed according to local haematuria guidelines.)

  • Abdominal mass identified clinically or on imaging thought to arise from urinary tract. Includes solid renal masses, complex renal cysts (i.e cysts containing septa, calcification or soft tissue elements) and soft tissue bladder masses.

Penis

  • Any suspected Penile cancer. Includes a penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause. For lumps in the corpora cavernosa that do not involve the penile skin, please use the routine referral process  or see local Peyronies disease guidelines .
  • Unexplained or persistent symptoms affecting foreskin or glans. This excludes simple phimosis. Underlying fungal infection or balanoposthitis should be excluded or treated before 2WW referral

Guidelines on making a referral

From the 21st May 2018 the format of the urology one stop clinic is changing to provide a more streamlined service for those patients referred as 2 week wait patients. 

Please refer 2ww patients using the above Proforma through eReferral. The clinical information you enter on this form will directly affect the booking of slots for these patients. Please try and avoid ticking more than one box on the referral forms. 

Suspected bladder or renal cancer

Patients who are referred with haematuria will be booked into direct slots with flexible cystoscopy and upper tract imaging on the day for the majority of cases. There may be instances when demand is greater than capacity and patients will need to return for diagnostic investigations. 

Please ensure that the clinical details are accurate so we can ensure the appropriate use of diagnostic slots:

If a patient is referred with non visible haematuria they will have a slot with a flexible cystoscopy and ultrasound on the day. 

If a patient is referred with visible haematuria they will have a slot with a flexible cystoscopy and a CT urogram on the day. 

Please document the patients EGFR on the 2ww referral form so we can book directly and safely into a CTU slot.

Suspected prostate cancer

Patients who are referred with suspected prostate cancer will be seen on our new prostate pathway. For some patients this will include a same day MRI and consideration for prostate biopsy based on the results. 

Suspected testicular cancer

Patients with suspected testicular cancer should be referred straight to test on ICE for direct access to the fast track testicular cancer pathway.

Patients will be seen for an ultrasound and if there is a suspicion of testicular cancer they will be booked into a Urology fast track appointment the same day. If the ultrasound does not show cancer the results will be explained to the patient and they will be discharged back to primary care.

Suspected penile cancer

Will be seen and assessed clinically and a decision made about on-going diagnostics.

 

Patients will be sent a leaflet about the one stop clinic and there is also information on the BUI website.