We operate a triage system in both private rooms and public clinics. Please fax the referral to the venue where you wish the patient to be seen and Mr Brough will review it promptly and allocate an appointment priority. The rooms or clinic staff will contact the patient with the appointment date and time. Please don’t send your referral to more than one place as this can become very confusing for patients and staff.
At Urology North, all urgent patients will normally be seen within one week in specifically allocated urgent slots. In the public clinics, most urgent cases will usually be seen within 3 weeks or sooner if clinically necessary. Mr Brough is happy to be contacted by telephone about urgent problems.
facsimile 03 6331 3666
phone 03 6331 9645
Launceston General Hospital Specialist Clinic
facsimile 03 6348 7197
Outpatient Department at the Mersey Hospital Latrobe
facsimile 03 6426 5687
In the last 3-5 years, we have become much more selective with regard to which cancers actually need treatment and which can monitored with active surveillance. Patients can thus be reassured that they may only be offered radical surgery or radiotherapy (with their attendant risks) if they are really thought to need it.
Please consider screening men over 50 (and men over 40 with first degree family members who have prostate cancer) with both PSA and DRE. A clear counselling process should precede screening and you may find the information in the link below helpful. Some men will decline screening based on a relatively high chance of their quality of life being affected by treatment for a “disease” which would never have killed them if they had never known about it. Their prerogative should be respected.
Macroscopic haematuria should always be investigated with an estimate of the patient’s blood pressure, a MSU, a serum creatinine and eGFR, a CT-IVP (also known as a CT Urogram) and a flexible cystoscopy. Use of IV contrast should be avoided in cases of IV contrast/iodine/shellfish allergy and poor renal function. If your patient is on Metformin, please let Radiology know as there are rare reported incidents of fatal lactic acidosis as a result of an interaction between IV contrast and this drug.
SYMPTOMATIC microscopic haematuria should be managed as macroscopic haematuria.
ASYMPTOMATIC microscopic haematuria is better not tested for routinely as the false positive rate for the test to detect any pathology is so high. However, if you do find it, a BP check, a MSU (look for protein), a serum creatinine/eGFR, an USS of kidneys and bladder and a discussion with an urologist about the advisability of flexible cystoscopy should screen most patients quite well. Patients with proteinuria and/or abnormal renal function may have IgA nephropathy. Phase contrast microscopy for dysmorphic red cells can be helpful and a nephrology referral may be appropriate.
Urine cytology has a high false negative rate for detecting urothelial carcinoma of the bladder and isn’t usually helpful in the initial screening of haematuria patients.
Please note that the above is generic advice and may need to be tempered according to an individual patient’s presentation.