Who should the patient see?
Complex, procedural, or surgical
- Cancer discussions — elevated PSA, suspected or known prostate / kidney / bladder cancer
- Complex or indeterminate renal cysts — need adjudication and a risk / benefit / alternatives discussion of observation vs. treatment
- Procedural or surgical decision-making
- Actual surgical needs
- Any complex medical decision-making
Place the ambulatory referral to Baytown Urology without naming a physician — we sort out which urologist internally. (If the patient is already established with one of us, say so and we’ll keep them there.)
Non-surgical, medical, or workup — seen first
- Medication management — BPH, ED, catheter / med management
- Infectious / inflammatory — recurrent UTIs and similar
- Simple (benign-appearing) renal cysts
- Positive urine dipstick not yet confirmed on micro — recheck first (see hematuria note)
- When you’d like urology to do the workup — e.g., you want us to order the CT urogram or prostate MRI
- Most urinary retention — female, post-operative, and chronic Foley management (see below)
Name Catherine Valencia, NP directly on the ambulatory referral for simple, non-operative problems — it goes straight onto her schedule with no internal triage step.
Send to a physician even if the patient only wanted a prescription
- Gross hematuria
- Urinary retention — though most of it starts better with the NP (female, post-operative, and chronic catheters). How we route retention →
- Recurrent UTI in a male patient
- Abnormal PSA or a palpable abnormality
- A ureteral stent that has been in for months, or whose original indication no one can identify
Urinary retention — how we route it
Most retention is managed medically, and Catherine can usually get to it sooner. This is triage we handle inside the office: it pairs the patients who may benefit from surgery with a surgeon more quickly, and gets everyone else started sooner. We are glad to see any of them — it is a question of who sees them first.
Void trials go in an early-morning slot, so a trial that fails still leaves a full day to act on it.
Void trials, medical management, chronic catheters
- Female urinary retention — the majority of it, as an early-morning void trial. (Prolapse- or pelvic-floor–predominant → gynecology.)
- Post-operative retention after a non-urologic surgery — also an early-morning void trial. Most of these resolve without any urologic intervention.
- Chronic incomplete emptying in women — voiding fine but never quite emptying, and the recurrent UTIs that tend to come with it. Rarely surgically correctable, and Catherine manages both.
- A chronic Foley being managed long-term — male or female. When there is nothing correctable behind it, or an operation is not the right answer for that patient, Catherine manages the catheter and brings us in if that changes.
- The medical management that goes with all of it — starting tamsulosin and finasteride, a bowel regimen, and running the void trial itself. Time-consuming to do well, and she does it routinely.
Discharge with the Foley, place the ambulatory referral naming Catherine Valencia, NP, and note “retention — needs early AM void trial.”
When something correctable is already identified
- A documented large prostate — the usual reason to start with a surgeon
- Another identified, surgically correctable cause — urethral stricture, false passage or traumatic catheterization, bladder stone
- Clot retention, or a Foley that will not drain
- Men with chronic retention, or recurrent UTI / prostatitis, who are fit for surgery. HoLEP can improve these substantially and sometimes resolves them — please send them, they are worth the conversation. The deciding piece is whether an operation is a realistic option for that patient right now — for many people going home with a catheter it is not yet. Those start with Catherine, and we take another look as they recover.
- The patient wants to discuss a suprapubic tube — an outpatient conversation with a urologist, not an urgent one
Ambulatory referral to Baytown Urology, no physician name.
Not sure? Send it to Catherine. If someone turns out to need a surgeon, we move them internally — no new referral, and usually sooner than waiting on a physician slot. You do not have to make that call from the outside.
What helps us most on a retention referral: the volume drained at catheterization, prostate size if it is already known, whether the catheter went in easily, and the current medication list. If the patient is already on tamsulosin, say so.
How our team works — and why the NP is the right first visit for many patients
Catherine Valencia, NP and Sandeep Mehta, MD practice as one team. Many urology problems — medication management, infections, catheter care, stable follow-ups, and getting the workup started — are handled expertly by Catherine, often with a shorter wait for an appointment.
We refer internally with no extra step or new referral for the patient. If something turns out to be surgical, complicated, or needs urgent evaluation, Catherine brings Dr. Mehta in — frequently during the same visit. A visit with the NP is not a downgrade; it’s the right entry point for many problems, with the physician right there when needed.
Meet the team: Sandeep Mehta, MD · Catherine Valencia, NP
Please have your patient bring their records
This is the single biggest thing that prevents delays — especially for records from outside Houston Methodist, which often do not reach us in time. Ask your patient to bring everything to the appointment:
- Lab results
- Imaging reports — CT, ultrasound, MRI reports
- Imaging discs (CDs) — the actual images, not just the report
Full patient instructions: Before Your Visit →
How to refer
- Simple, non-operative (medications, infections, catheter management, stable follow-up, retention void trials) → name Catherine Valencia, NP.
- Everything else → Baytown Urology, no physician name. We assign the right urologist internally, which is faster than guessing.
Epic referral order
Place an ambulatory referral to Urology — Houston Methodist Baytown.
Fax: (281) 428-4750
Phone 832.556.6046
4201 Garth Road, Suite 307, Baytown, TX 77521
Faxing? Please send all clinical information with the referral — the office note / reason for referral, relevant labs, and imaging reports. A faxed referral without clinical information can’t be triaged or scheduled, and will be delayed. (An Epic referral carries the chart automatically.)
Pre-referral workup (helpful, not required)
You can order these directly, or refer to the NP first and ask urology to order them — either way speeds scheduling and triage.
| Reason for referral | Suggested workup before / with referral |
|---|---|
| Suspected stones / renal colic | Non-contrast CT (stone protocol), urinalysis, basic metabolic panel |
| Elevated PSA | Repeat PSA (rule out UTI first); prostate MRI |
| Hematuria | Confirm on microscopic UA first — see the hematuria note below |
| Scrotal mass or pain | Scrotal ultrasound |
| Hydronephrosis / rising creatinine | The flagging imaging, plus recent renal function |
| Urinary retention (Foley in place) | Volume drained at catheterization; basic metabolic panel; prostate size if any prior imaging reported it. Defer the PSA — it is unreliable during retention and after instrumentation |
Hematuria — a quick note for PCPs
- Confirm before working it up. A positive urine dipstick alone is not hematuria — recheck with a microscopic UA (≥3 RBC/hpf) and rule out a benign cause first (UTI, menstruation, recent vigorous exercise or instrumentation). An unconfirmed dipstick needs no hematuria workup or imaging.
- A CT urogram before or with referral is welcome in the higher-risk groups — gross hematuria, older patients, or a current/former smoking history. It speeds the workup.
- For low-risk confirmed microscopic hematuria (younger, never-smoker, no other risk factors), imaging is not required up front — refer and we’ll risk-stratify.
- Cystoscopy is arranged by urology — no need to order it.
Reaching me
Easiest is Epic Secure Chat or the Epic On-Call Finder. Our internally-updated urology on-call calendar: Urology On-Call Calendar → (Houston Methodist sign-in).
Many inpatient consults are managed by ruling out an emergency, stabilizing the patient, and arranging outpatient follow-up — the full workup doesn’t always need to be completed before discharge. At discharge, place an ambulatory referral to Urology. Hospital-team discharge checklists & patient handouts: inpatient.drmehtaurology.com.
Who to route to at discharge
Procedural · complex · red flag
- Cancer or suspicious imaging — renal mass, bladder mass, abnormal PSA
- Gross hematuria needing cystoscopy
- Stones needing intervention; stent or nephrostomy; obstruction
- Outlet obstruction or urethral stricture
- Retention where the team has documented a large prostate or another surgically correctable finding
- Urgent surgical pathology — call directly
Medical · management
- Trial of void after retention (Foley at discharge) — especially female and post-operative retention; book the early-morning slot
- Catheter care & Foley removal planning
- Chronic Foley maintenance, male or female — the common path for patients discharged with a catheter
- Incidental chronic incomplete emptying — a residual noticed in passing, with normal creatinine, no recurrent UTIs and no pain. Common in women, and a routine outpatient follow-up
- Recurrent UTI, epididymitis, pyelonephritis — medical follow-up
- Mild / incidental hydronephrosis, stable function
- Uncomplicated small-stone follow-up
Detailed routing by finding
| Appropriate for the NP first — name Catherine Valencia, NP | Prefer a urologist — refer to Baytown Urology, no physician name |
|---|---|
| Incidental chronic incomplete emptying — picked up on an inpatient scan, asymptomatic: normal creatinine, no recurrent UTIs, no pain or discomfort. Especially in women | The same picture with rising creatinine, hydronephrosis, recurrent infection, or discomfort |
| Chronic incomplete emptying in a woman — voids, but never fully empties, with or without the recurrent UTIs that go with it | Men with chronic retention, or recurrent UTI / prostatitis, who are fit for surgery — HoLEP may improve or resolve it, so these should get a surgical opinion |
| Chronic Foley — routine maintenance and exchanges. Male or female, with nothing correctable identified and no operation planned. We escalate internally if that changes | Only if a surgically correctable cause is already documented (large prostate, stricture, bladder stone), or there is clot retention or bleeding |
| Acute urinary retention with Foley; needs trial of void — including after a trial that has already failed | A documented large prostate, bladder stones, urethral stricture, or another surgically correctable finding on imaging |
| Female urinary retention — effectively all of it. Book the early-morning void trial. If it turns out to need a surgeon, we sort that out internally | Prolapse / pelvic-floor–predominant → gynecology (not urology) |
| Post-operative urinary retention after non-urologic surgery — Foley at discharge, early-morning void trial. Most resolve conservatively | Post-op retention where the primary team has identified a documented large prostate, a known stricture, or another surgically correctable finding |
| Catheter care and Foley removal planning | Urethral stricture, traumatic catheterization, false passage, or difficult Foley placement |
| Mild or incidental hydronephrosis, stable renal function, no infection | Hydronephrosis with AKI, infection, pain, solitary kidney, bilateral/severe, mass, or suspected obstruction |
| Recurrent UTI, epididymitis, pyelonephritis — medical follow-up via PCP or urology NP | Obstructed infected stone, abscess, emphysematous infection, fistula, hardware complication — or any infection with a significant urologic finding |
| Simple or benign-appearing renal cysts | Renal mass, complex/enhancing cyst, bladder mass, or suspicious bladder imaging |
| LUTS requiring medication review | Gross hematuria — especially recurrent, unexplained, or with clots (needs cystoscopy) |
| Uncomplicated small stone follow-up, pain controlled, no urgent surgical issue | Ureteral stone with stent, nephrostomy, AKI, infection, solitary kidney, recurrent ED visits, large stone, or persistent obstruction |
| An indwelling ureteral stent in place three months or longer, or one whose original indication cannot be identified — needs the outside records pulled and a decision made. Do not send this to a routine slot | |
| Scrotal abscess, Fournier’s concern, torsion concern, or other urgent surgical pathology — call urology directly |
A few routing notes that apply to both settings
- Infectious / inflammatory (recurrent UTI, epididymitis, pyelonephritis) are often medical, not surgical. Once the acute episode is treated, refer to a urologic surgeon mainly when there is a significant urologic finding (retention, obstructing prostate, stones, hydronephrosis, abscess, or suspicious imaging); otherwise PCP or our urology NP can manage and screen for contributors.
- Pelvic organ prolapse / female pelvic health: our group does not currently have a pelvic-health / prolapse specialist — please refer prolapse and pelvic-floor–predominant cases to gynecology. Female urinary retention without prolapse is appropriate for urology (NP first).
Information that helps scheduling & triage
- CT / ultrasound date and result; laterality (right, left, bilateral)
- Creatinine trend; urine culture if available
- Foley status; stent or nephrostomy status
- Anticoagulation status; whether hematuria has resolved
- Whether pain is controlled; fever / infection, AKI, solitary kidney, or recurrent ED visits
- For retention: volume drained, prostate size if known, whether the catheter was difficult to place, and whether a void trial has already failed
- For a stent or tube: why it was placed, who placed it, and roughly how long it has been in — if the patient does not know, say that rather than leaving it blank
Example referral wording:
“Ambulatory referral to Urology — gross hematuria resolved inpatient; needs outpatient hematuria evaluation.”
“Ambulatory referral to Urology — urinary retention discharged with Foley; needs trial of void.”
“Ambulatory referral to Catherine Valencia, NP — post-op urinary retention after right total knee, Foley in place, volume drained documented; needs early AM void trial. No known prostate issue.”
Red flags that should not wait for routine outpatient follow-up
- Fever / sepsis with urinary obstruction; obstructing stone with infection
- Solitary kidney with obstruction, or bilateral obstruction with worsening function
- Uncontrolled pain or vomiting
- Clot retention or a Foley that will not drain
- Severe scrotal pain concerning for torsion; concern for Fournier’s gangrene
- A ureteral stent that has been in place for months, or with no identifiable indication — encrustation risk climbs with time