Urology - Referral Guidelines
The Division of Urology at Children’s National Medical Center is the area’s largest and most experienced group
of physicians trained especially to treat children with illnesses of the genitourinary tract. Children’s National
pediatric urologists have more than 100 years of combined experience in the diagnosis and treatment of all
genitourinary disorders in infants, children, and adolescents. This includes genital reconstruction (undescended
testes, hernias, hydroceles, hypospadias, ambiguous genitalia), evaluation and surgical repair of congenital
and acquired urinary tract abnormalities (hydronephrosis, posterior urethral valves, vesicoureteral reflux,
neuropathic bladders), evaluation and medical management of daytime and nighttime wetting, urinary tract
infections, and vesicoureteral reflux. Phone consultations from physicians are encouraged. The physician
referral line is 202-476-2670.
Parents may arrange outpatient consultations by phoning 202-476-5042 (option #2). However, evaluation of
children who may need imaging studies for urinary tract infections or hydronephrosis is best arranged through
the hospital office (202-476-5042 option #3). To reduce the number of trips for the family, radiographic and
sonographic evaluation will be arranged for the date of consultation. If studies have been done previously, these
should be sent with the patient at the time of the initial visit.
The Division of Urology compiled the following guidelines to assist referring physicians in the evaluation and
management of pediatric patients presenting with common urological problems. You can also download a pdf of these guidelines.
For additional reference, view
Pediatrics, Vol. 110, No 1, July 2002.
- Tight foreskin, inability to reduce the foreskin in boys older
than 12 years of age that does not improve treatment with
at least 6 weeks with steroid cream application.
(Betamethasone cream 0.05% applied to foreskin opening
twice a day for 6 weeks.)
- Tight phimosis causing ballooning of foreskin with voiding
which persists after treatment with steroid cream as above.
- Documentation of recurrent (more than 2 episodes)
infection of the glans (balanitis), foreskin (posthitis), or
- Documentation of urinary tract infection in males, especially
if associated with abnormal renal US and/or VCUG; a congenital
urinary tract anomaly (hydronephrosis, vesicoureteral
reflux, posterior urethral valve, prune belly syndrome,
- History of paraphimosis (inability to replace foreskin over
glans penis after it has been retracted).
- Trauma to the penis, especially the foreskin.
- We do not recommend routine referrals for elective,
non-medically indicated circumcisions in boys older than
one month of age
- Clinic notes
- Pertinent laboratory data
Urinary Tract Infection
- Any child with documented febrile UTI
- Any male with a documented UTI
- A female with 2 or more occurrences of afebrile symptomatic UTI.
- Document urine clearance after appropriate therapeutic treatment for a febrile
UTI then place the child on suppressive antibiotics. Prior to the evaluation,
children should be on suppressive antibiotics. (Prophylaxis dose = 1/4 daily
- Any child with symptomatic UTI and congenital spinal dysraphism
(myelomeningocele, sacral agenesis) should be referred to the Spina Bifida
Clinic with a request to see a Children’s urologist.
- Clinic notes
- Urine culture documentation (include all)
- For patients who have undergone US and/or VCUG have patient bring films or CD to
- Patients who have not had studies should call 202-476- 5042 (option #3) to set
up appropriate imaging studies and consultation at Children’s.
Voiding Dysfunction, Daytime Wetting, and/or Nocturnal Enuresis:
- Refer to WASH Clinic (Wetting and Soil Help) :
- Children older than 7 years with isolated bed wetting.
- Children older than 7 years with day and night wetting.
- If less than 6 years old.
- Refer to a pediatric urologist when:
- Any child with a febrile urinary tract infection with abnormal renal US and/or
- Any child with a congenital anatomic genitourinary anomaly (posterior urethral
valve, vesicoureteral reflux, hydronephrosis, ureteropelvic junction
obstruction, bladder or urethral abnormalities, or genital malformation)
- KUB, Urine culture results
- KUB and pre/post renal bladder sonogram, urine culture results
- No studies before referral, Urine culture results
- Clinic notes
- Urine culture documentation, if available (include all)
- If radiologic studies have been done, send reports with referral. The patient
should bring films or CD to the appointment
Undescended testes, Hydroceles, hernias:
- Hydroceles that persist beyond 18 months of age (hydroceles in infants usually
- Reducible hernias.
- Testicles should be in the scrotum by 6 months of age. Referral should be made
if that is not the case or if neither testicle can be felt as a newborn.
- No imaging studies should be done prior to referral. Sonography rarely adds to
- Refer between 3-4 months of age.
- No imaging studies prior to referral
- Unilateral with normal contralateral kidney – refer 3 to 4 weeks of age.
- Bilateral or solitary kidney – contact pediatric urologist as soon as possible.
- Bring prenatal and postnatal imaging (films or CD) (postnatal sonogram at 2-3
weeks of age)
- Bring prenatal and postnatal sonogram films or CD, lab work