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
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
You can name Catherine Valencia, NP on the referral, or simply note “to Urology — NP for infectious / inflammatory / medication management.”
Send to Dr. Mehta even if the patient only wanted a prescription
- Gross hematuria
- Urinary retention
- Recurrent UTI in a male patient
- Abnormal PSA or a palpable abnormality
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
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 |
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
- Failed void trials, outlet obstruction, urethral stricture
- Urgent surgical pathology — call directly
Medical · management
- Trial of void after retention (Foley at discharge)
- Catheter care & Foley removal planning
- Recurrent UTI, epididymitis, pyelonephritis — medical follow-up
- Mild / incidental hydronephrosis, stable function
- Uncomplicated small-stone follow-up
Detailed routing by finding
| Appropriate for NP follow-up first | Prefer doctor / surgeon follow-up |
|---|---|
| Acute urinary retention with Foley; needs trial of void | Recurrent failed void trials, catheter dependence, very large prostate, bladder stones, or chronic outlet obstruction on imaging |
| Female urinary retention requiring initial evaluation | Female retention with complex anatomy, neurogenic concern, or InterStim pathway. Prolapse / pelvic-floor–predominant → gynecology |
| 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 |
| 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
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.”
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