Urology induction booklet was contributed by the following;
written by Dr Devyani Bhatt
reviewed by Mr Abedin
revised, updated and edited by Mr. Taha Chaudhry
Select the titles below, to expand the table for more the information.
Urology Team
Each consultant has an on-call week (08:00 Monday to Monday), during which they will do a ward round every day. Any new patient admitted in during these times will be under their name. Most consultants prefer to start the ward round around 09:00, some will start at 08:30 or in between these two times.
Consultants
| Consultant | Secretary | Extension |
|---|---|---|
|
Mr Asad AbedinS |
Michelle Hodgetts |
2142 |
|
Mr Paul Anderson |
Joanne Mole |
2203 |
|
Mr Sarvpreet Ubee |
Hannah-Marie Husband |
2870 |
|
Mr Syed Ali Shahzad |
Chloe Davies |
2201 |
|
Mr Adel Shafik |
Chloe Bennett |
4451 |
REGISTRARS
They will take it in turns to hold the on call bleep, do the ward rounds as well as attend theatres/clinics/wards
They will be the ones generally discussing patients with radiology and also doing discharges if seeing new patients on SAEC. Referrals should go through them before being accepted as a urology patient. They can be called to help out with really difficult catheters too!
SENIOR HOUSE OFFICER
Usually a core trainee, he/she will help you with jobs but their time will probably be spent in theatres and possibly clinics too! They can always help you with difficult cannulas/ signing off your core procedures/Mini-CEX’s. There is plenty to learn from them so make the most of it!
PHYSICIAN ASSOCIATES
There is a physician’s associate who will help you on the wards with all ward jobs and reviews, except prescribing. They are a permanent member of the ward team and provide consistency while you rotate.
They will also be helping out the consultants in clinics and helping registrars with reviews
They help with ward round, TTOs, discussing with other teams, bloods, cannulas and updating the list.
NURSES ON THE WARD AND OTHER STAFF
Nursing team: can (and will do if asked nicely) your bloods, cannulas, ECGs, catheters (obviously, it’s Urology) and hugs when you are stressed.
Pharmacist: consistently and constantly saving your patients from you. They will also be sorting out your TTOs, your drug charts, drug histories and questioning why your patient is on day 13 of IV Tazocin. Help them by making your discharge papers comprehensive, your drug charts legible and yourselves accessible via bleep.
Ward clerk: will provide pens if you ask nicely but also help locate patients, put patients back on JAC (for you to do discharge papers after they have left) and find old notes. They are also a huge help with finding forms/paperwork/admin papers.
Urology Lists
Log in
- You will need access to the SUV teams, if you don’t already have access you will need to speak to Marium Parvez. Once you have access, log into teams using your login and you should have a tab saying urology on the side.
Click on urology and find the correct month and date for the list.
Once you have accessed the list, go through the patients on C6 and cross-check with sunrise tracking board that all the patients are in the right bed numbers/ have they been moved/have they been discharged.
To access the on take list, you will need to open new tab, log into teams there and you will have an option to click on general surgery. Click on that and then open up the on take lists, click on today’s list. There will be a lot of different sections, find the urology section and then essentially transfer the patients across to your urology WR list in your other tab. Make sure to check the locations of the patients and enter appropriately, some patients will be in ESH, others will be outliers and some may have even been discharged, so try your best to ensure you have added in patients appropriately to the list.
- Go to Sunrise and go to ward B1 on tracking board, this is where most of the elective post-op patients will be. Check which patients are under the urology consultant’s name. This is important, patients under any of the urology consultants’ names will need to be added to the WR list and seen on WR. So, not just the on-call consultants patients but all post-op urology patients.
- Following that, you will need to check the rest of the WR list, there will be patients all over the hospital, just check those patients are in the right location by double-checking with sunrise.
Emailing Secretaries
When you discharge a patient, you need to let the relevant secretary know any plans made in terms of follow up.
‘Hi,
Please could you add the patients below to follow up:
Roger Smith, 123455, 1/2/65 Follow up with Mr Ubee in 6 weeks time post TURBT
Thanks!’
(Add all the patients at once at the end of the day rather than sending 5 over the course of 3 hours).
Urology - A Typical Day
A Typical day in Urology
Come to C6, update the list as outlined above (I recommend 7:55am start)
Registrars +/- consultant will start the If there are enough team members, you may split
-
- Have your NEWS scores and trends available
- Latest bloods
- When documenting, it is always good practice to write the problem list/ reason for admission
Registrars have various morning/afternoon commitments including clinics, theatre time, biopsies or being on call. This may mean that sometimes the registrar for Mr Anderson for example, will come and see all of Mr Anderson’s post op patients then leave. This can sometimes seem confusing but there is order in the chaos.
Split jobs between the juniors and physician associates. Try to complete all your TTOs and discharge letters before lunchtime as you will get pressured to do so. Also remember that one F1 must carry the bleep everyday.
Don’t forget to order bloods for tomorrow. You can create your own little ‘blood set’ on Sunrise and can put the form out as a ‘repeat’. My blood set normally is made of full blood count, CRP, renal and liver profiles. On sunrise go to: Preferences > Order entry > Add new. Then enter your bloods as normal, setting the time to T+1 for tomorrow, T+2 for day after tomorrow etc. You then choose this set via ‘My personal order sets’.
Email relevant secretaries with follow up plans for your discharged patients (list found in the office matching consultants to their respective secretaries).
Let the Urology Hospital to Home nurses know about the patients that need to be TWO C’d in the community. This can be done via Sunrise if they are not in the office with you. Tell them how much water is in the balloon for the catheter. It is good practice even if you ask the team verbally to always do a referral on Sunrise as well.
If there are enough of you, do not waste time. Go see prostate biopsies (happening on C6), theatres and ensure to complete your Mini-CEX/CBDs early. Try to do some relevant SCRIPT modules. All of the consultants and registrars are friendly and always keen to involve you if you get involved.
Other things to help you
Do your discharges as urology has a high turnover. This means that there is enough time for nurses to get the TTO to pharmacy, for you to correct your mistakes (inevitable, don’t worry), for the notes to go to anti-coag if appropriate, hit cut offs and book ambulances.
Prioritise any discussions with departments earlier in the day. Remember ward doctors leave at 5pm, so don’t leave your discussion with the endocrine registrar until 16:50.
By 5pm, your list should be updated for the following day and bloods put out for the phlebotomists tomorrow. To save the updated list, save as copy online but rename with tomorrow’s date.
Any bloods done in the afternoon may have to be put on the Nerve (access via hub) for the on call Be a good colleague and give a plan of action based on the bloods. Don’t leave the poor FY1 dealing with a sodium of 122 at 9pm if you already know that’s what you are monitoring.
Ask your seniors for help. Update them on any issues or deranged bloods. Only registrars are supposed to take referrals.
Prep TTOs for patients that will be going home over the weekend so it is easier for your solo weekend.
Pre-op and bleeding patients may need a group and save. Get it done sooner rather than later (Group and Save blood forms are still on paper).
Urology Elective Procedures & TTO Plans
The procedures outlined below are commonly carried out in Russells Hall hospital. There will obviously be others, but you will be able to learn about them from your seniors, the operation notes and Google.
Select the titles in red below to find out further information.
- If elective generally the ECG/bloods are carried out
- Emergency bookings:
- Hub > Theatre Emergency Bookings > Fill out self-explanatory form.
- Bleep the anaesthetist and theatre (the form will tell you to do it anyway).
- May require: Bloods, ECG, Group and Save,
- NBM (ask surgeon if not sure when to starve from).
- Two-part procedure for disease of the urethra (strictures/damage from iatrogenic causes to name a couple).
- Penis is cut open and the diseased urethral layer is removed.
- 1st stage includes taking a graft often from the cheek (BUMG) or from the tongue (LMG) is taken and quilted into place.
- 2nd stage includes suturing up the urethral layers back into place roughly 6 months after.
- Mr Anderson is the primary surgeon for these operations and as this is quite niche, you will have patients from all over the region, not just Dudley.
- Mr Anderson has a strict post-op plan:
- Bactroban (mupirocin 2% ointment) 3-4 weeks.
- Difflam mouthwash 3-4 weeks.
- Catheter care will be outlined by him including its removal. FOLLOW HIS STRICT CATHETER CARE PLAN.
- Removal of prostate for BPH
- ThuLEP and HoLEP are laser based
- Post-op: bloods generally to check U&Es
- Removal of bladder tumour.
- May involve giving Mytomycin C (chemo drug), this will be sorted by the nurses and seniors anyway.
- Post-op: await MDT and histology results, TWOC instruction included.
- Removal of bladder tumour.
- May involve giving Mytomycin C (chemo drug), this will be sorted by the nurses and seniors anyway.
PLEASE NOTE: Do not say yes to giving mitomycin unless you are trained, many nurses will try to ask you but you need to be specifically trained to give it. - Post-op: await MDT and histology results, TWOC instruction included.
Urology Emergency Admissions
Select the titles in red below to find out further information.
- Monitor Hb and vitals.
- Can go into clot retention (clot causes block. Block causes retention);
- 3 way catheter with regular bladder washouts + PRN too. Great opportunity to try and insert one yourself, the core surgical trainees and registrars are always keen to teach.
- If this is not helping, will need irrigation.
- Investigations: USS KUB which can be requested via Sunrise or manually put on the SAU list if the patient is on B5 (purple form, the clipboard is in ESH station 1).
- On discharge will need a rapid access flexible cystoscopy (arrange via Sunrise).
- Always a good idea to get a group and save done just in case.
- If you get called to review the patient, look at what is in the catheter itself rather than just the bag.
- Always ask about residual volume.
- Usually bladder scanned, catheterised and sent home with aim to TWOC in community in 2 weeks.
- High pressure and multiple failed TWOCs are the worrying patients – your seniors will help you out (don’t worry). In high pressure chronic retention patients, you need to strictly monitor their output to check they are not diuresing.
- Must be proven on CTKUB/known to urology for troublesome stones beforehand to be taken over by urology.
- A 3mm found in the renal pelvis which is not obstructing is not a reason to take over patient. This will not be your job to argue but it’s good to be aware of protocol.
- If obstructing, causing hydronephrosis or clinically appropriate will be booked into emergency theatres/next available list.
- Often if the presenting complaint is renal colic, patients can be sent home with an outpatient CTKUB in 4-6 weeks.
- Hydronephrosis on USS? May need to talk to IR (Dr Ajayi, Dr Randhawa, Dr Latif) for a nephrostomy.
- This is an urgent situation. Kindly locate your registrar.
- Treat with antibiotics, keep an eye on CRP/WCC and renal function.
- Discuss with Micro Consultant before you start them on Tazocin/meropenem/ IV coamox etc. Pharmacists will only supply this for a few days and then cut you off unless it has been discussed. Dudley has Tazocin resistance. Please be a good antibiotic steward. (And also check allergies).
Urology Discharge Papers
Select the titles in red below to find out further information.
You cannot get away from them.
They know who you are.
They know your bleep.
They will find you!
Discharge papers are written to aid consultants in their follow up clinic. GPs use them to make sense of why their patient had been started on 30 different drugs and have one fewer kidney since their last consultation. And You! When you clerk a patient in during your inevitable medical on calls, previous TTOs will be invaluable to you to find the drug history, previous medical history and any current outstanding issues.
- This is self-explanatory.
- If they had a procedure, document if this was elective or emergency.
- Haematuria, abdominal pain, renal calculi are suitable entries here.
- AKI alone is not a suitable entry.
‘Pyelonephritis with AKI’ is acceptable. - Often adding in relevant past medical hx can also be helpful.
- “Mr Smith attended hospital complaining of… /with… /for a…”
- If they had a procedure:
- Indication
- Findings +/- complications
- Any complications such as an AKI/infection/fall etc.
- Any investigations with their brief summary
- Post-op plans (no need for things like routine obs. But things like TWOC in 2 weeks, follow up in 6 weeks. Be meticulous about Mr Anderson’s catheter plans too).
- Specialist nurses do telephone consultations and face-to-face ones. Specify which it will be.
- If the patient is coming back in 4 weeks for a CTKUB. Book the CTKUB on sunrise and write ‘In 4 weeks please’ in the free text.
- If you are carrying out an investigation for a patient whilst an inpatient, it is your responsibility to arrange suitable follow up. Don’t leave the GP with a 16 point plan to action. ‘Please review U&Es in a week’s time’ is a sensible request.
- Hot Clinic
- A clinic that is carried out on the ward C6 for wound reviews/catheter issues/ follow up bloods. There is a book that is looked after by the ward clerk in which you need to input details and let relevant parties know about.
- Don’t forget to do sick notes if appropriate.
- Medications that were started (and why)
- Medications that were stopped (and why)
- Medication that were held during admission (and if they need to be restarted/ reviewed)
- Doing this bit will save your time and the pharmacist’s time and the GP’s time. Everybody wins!
- Make sure your frequency, times and duration are correct
- Controlled drugs (Tramadol, opioids) need to be handwritten on the TTO after (just ask the pharmacist/seniors to teach you how. You need to write down how many capsules/tablets you want supplying. E.g., if you prescribe tramadol 50mg, QDS for 4 days, you have to write ‘Please supply sixteen (16) capsules.
- If the patient has been an inpatient for less than 48 hours, you only need to prescribe new or altered medications e.g., antibiotics.
- Patients who need mediboxes and have been an inpatient for >48 hours will need all the meds written up.
- Insulins, anticoags and PRN drugs are easy to miss, so remember to check.
- Patients on anticoagulation will need to be dosed in the anticoagulation clinic (cut off is 4pm) and need an anti-coag referral + most recent INR if appropriate.
On the whole urology is a really rewarding speciality, it is busy and has a high turnover rate so you will get asked to do things quickly and with experience, a lot will become faster. Make sure to speak to seniors if you are unsure and also take the opportunities to go to theatres and clinics as much as you can. As long as there is enough cover – they will be pleased to have you.
