Urinary tract calculi Referral Access Criteria

Referrers should use this page when referring patients to public adult urology outpatient services for urinary tract calculi.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Proven (obstructing) ureteric stone in patient with single kidney or kidney transplant Acute renal or ureteric colic with obstruction and infection Acute renal failure Urinary tract calculi in pregnancy Uncontrollable symptoms (e.g. pain or vomiting)

Immediate referral
Immediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
Nil To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Calculi in ureter proven on imaging Staghorn calculus Symptomatic renal calculi Pain or difficulty urinating Lower abdominal pain/flank pain Asymptomatic renal calculi ≥5mm Asymptomatic renal calculi <5mm (found on imaging) which have not passed within 4 weeks

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset, duration and severity of symptoms Current medication list Any known allergies
Examination	Nil
Investigations	FBC U&E Non-contrast CT KUB or urinary tract ultrasound (US)

Highly desirable
History	If patient has passed previous stone and this has been examined, include details of calculi
Examination	Nil
Investigations	MSU (or CSU) MCS X-Ray KUB Serum Ca Serum uric acid PTH

Indicative clinical urgency category
Category 1 Appointment within 30 days	Proven calculi in ureter and decreased renal function and/or increasing pain
Category 2 Appointment within 90 days	Proven calculi in kidney (non-obstructive) that the patient may wish to have treated operatively Staghorn calculus
Category 3 Appointment within 365 days	No defined category 3 criteria

Indicative clinical urgency category

Category 1

Appointment within 30 days

Category 2

Appointment within 90 days

Proven calculi in kidney (non-obstructive) that the patient may wish to have treated operatively
Staghorn calculus

Category 3

Appointment within 365 days

Exclusions
Small stones <5mm that have a good chance of passage May be observed in the community with analgesia and a follow up scan in 4 weeks, with guidance for patient to collect stone.

Useful information
Nil

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Last reviewed: 05-01-2024

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