Patient guide

Why does preparing help?

Most urological assessments begin with a conversation. For a man with urinary symptoms, the EAU recommends starting with a full medical and surgical history, and the NHS also says the doctor will ask about your conditions, medicines, diet and family history. The more precise your answers, the more targeted the assessment can be. Some subjects are hard to talk about, but your doctor hears about them every day. The NHS states plainly that embarrassment should not stop you from seeking help. If you would be more comfortable with a male or female doctor, or having someone with you, the NHS says you can ask in advance; ask the receptionist whether that is possible at your clinic.

What should we bring?

• Imaging records. The reports and the disc or files from earlier ultrasounds, CT scans and X-rays. If you have the images themselves, bring them with the report.
• Test results. Urine tests and cultures, creatinine, and, if you have had a PSA test, every value with its date. The EAU says that when interpreting a PSA value, repeating it in the same lab with the same method makes results more comparable.
• A list of medicines. Everything you take, including herbal products, supplements and over-the-counter medicines, with the name on the box. Some medicines affect urination or PSA, and the doctor needs to know.
• A stone you have passed. If you caught one, bring it in a clean, dry container. The NHS and NIDDK say that analysing the stone type helps decide on prevention.
• Notes on your symptoms. When it started, how often it happens, what makes it worse, and whether you have had fever, chills, nausea or blood.
• Family history. Kidney stones, prostate or bladder cancer, kidney disease. The NHS lists a family history of stones as a risk factor for recurrence.

The bladder diary

If your problem is with urinating, a bladder diary is one of the most useful things you can bring. The NHS says that when assessing an enlarged prostate, you will be asked to record what you drink and your urination for at least three days. The EAU also says to fill in the diary for at least three days, especially if you wake at night, and writes that three days gives a result close to seven. The simplest form is a table: the time, the amount of fluid you drank, the number of times and the approximate volume of each urination, and how many times you got up at night.

What should we bring for each problem?

Flank pain or stones. Earlier reports and images, the dates of earlier attacks of pain, and whether they came with fever. Mention a history of repeated urinary infections too.

Night-time urination or a weak stream. The bladder diary, your current medicines, and whether you have had a PSA test before. The EAU also uses a standard symptom questionnaire to measure how bothersome the symptoms are and to compare after treatment.

Blood in the urine. When you first saw it, the colour, whether there were clots, any pain, and whether you smoke or have smoked. The NHS says a rectal or vaginal examination, a urine or blood test and a referral may be needed. A referral does not necessarily mean cancer.

Not conceiving. The EAU says the couple should be assessed together, so bring your partner’s test results and reports too, if she agrees. Bringing your partner along is optional. The doctor will ask about lifestyle, conditions such as obesity, diabetes and high blood pressure, sexual infections, testicular surgery, and medicines or substances that harm fertility (EAU). If you have had a semen analysis, bring the original sheet and keep the date and the lab.

What questions should we ask?

• What is the most likely cause of my problem, and what is needed to be sure?
• What are my options, and what are the benefits and side effects of each?
• What might happen if I wait or do not treat it?
• Which signs mean I should not wait for the next appointment? The list is in urgent signs.
• When is my next appointment, and what should I do until then?

If a sample or a scan is planned, see the test preparation guide.

A reminder

This guide is for getting ready and does not replace an examination. If you have a sign listed in urgent signs, do not wait for the first visit.

Where do we start?

First find out what type of stone you have, because the advice differs. NIDDK gives different advice for calcium oxalate, calcium phosphate, uric acid and cystine stones. The lab tells you the type from a stone you have passed. So do not throw the stone away, and keep the result. NIDDK says that after a stone is removed, a 24-hour urine collection may also be requested, because a low urine volume and a high amount of minerals raise the risk of a new stone.

The advice below is general. If you have kidney disease, heart disease, diabetes or gout, or take a water tablet, talk to your doctor before changing your diet. The NHS also says not to overhaul your diet without advice.

1. Water

• NIDDK says fluid, especially water, is the most important thing you can do to prevent stones. The NHS suggests 2.5 to 3 litres a day for adults. The EAU sets the target as a 24-hour urine volume above 2.5 litres. Hot weather and exercise increase the need.
• Look at the colour of your urine: dark means you are dehydrated (NHS). The aim is pale urine.
• The NHS suggests mixing in fresh lemon juice, and NIDDK says citrus drinks such as lemonade and orange juice may help because they contain citrate.
• Cut down on sugary drinks, caffeinated drinks and alcohol, according to the NHS. In one trial quoted by the EAU, cutting sugary drinks reduced recurrence, but that single study is the only evidence.
• If you have kidney failure, your doctor should set your fluid amount (NIDDK). Cystine stones may need more fluid.

2. Salt

The NHS says adults should eat less than 6 g of salt a day. The EAU recommends about 4 to 5 g or less. Salt is not just what comes from the salt shaker. NIDDK says there is hidden sodium in baking soda, monosodium glutamate and nitrates or nitrites, and on a food label it counts 5 percent of the daily value or less as low and 20 percent or more as high.

3. Calcium: do not cut it

NIDDK and the EAU both say not to take calcium out of your diet. Calcium in food blocks the absorption of substances that form stones. The EAU considers about 1 to 1.2 g a day from food appropriate, and does not routinely recommend calcium tablets. Do not remove dairy and calcium-rich foods. If your stones are oxalate stones, NIDDK suggests low-oxalate plant sources such as juices, grains and calcium-fortified bread. Do not start calcium tablets or vitamins without a doctor’s advice.

4. Animal protein

For calcium and uric acid stones, NIDDK recommends eating less animal protein (meat, poultry, fish, eggs and dairy) and replacing part of it with beans, soy, nuts and seeds, without lowering total protein. The EAU gives a figure of 0.8 to 1 g per kilogram of body weight a day. This figure is not for everyone; the protein you need varies with age and illness, so your doctor or a dietitian should give the exact amount. NIDDK says a high intake of fish, shellfish and meat, especially organ meats, may play a part in uric acid stones.

5. Oxalate: only if your stones are oxalate stones

For calcium oxalate stones, NIDDK advises limiting these: nuts and peanuts, rhubarb, spinach and wheat bran. The EAU writes that someone with oxalate stones should also avoid taking a lot of vitamin C and avoid extra vitamins. If your stones are not oxalate stones, there is no need to fear these foods.

6. Other habits

• Weight and activity. The NHS lists inactivity among the risk factors, and NIDDK says excess weight raises the risk and losing weight is especially important for uric acid stones. The EAU recommends a reasonable weight and activity and says obesity, diabetes and metabolic syndrome go with stones.
• A balanced diet. The EAU describes a varied diet without excess, with plenty of vegetables and fibre. The role of fibre in preventing recurrence is not settled.
• Medicines. The NHS says some medicines, such as aspirin, antacids, water tablets and antibiotics, are linked to stone risk. Do not stop any of them yourself; just tell your doctor you have a history of stones.
• Preventive medicine. NIDDK says that depending on the stone type, a medicine may be needed too (for example for calcium, uric acid, struvite or cystine stones). This is your doctor’s decision, and you should not start one without tests and a prescription.
• Urinary infection. The NHS counts repeated urinary infections as a recurrence factor. Have burning or fever checked early.

What should we keep track of?

A simple chart is enough: how many litres of fluid, the colour of your urine, and any new pain. If severe pain, fever, chills or persistent vomiting develop, see urgent signs. After each new stone, or if the type of your stone is not known, contact your doctor again. More about stones themselves is on the Kidney and ureteral stones page.

A reminder

This routine is general and does not replace an individual assessment. Coordinate any change in diet or medicine with your doctor.

Which procedures is this guide for?

For stones and some conditions of the ureter and prostate, procedures such as extracorporeal shock wave lithotripsy, ureteroscopy, PCNL or placing a stent are used. Which one is chosen for you is a decision for your doctor and yourself, and only a summary appears on the kidney stones page and the prostate page. Here we cover only preparation.

According to NIDDK, extracorporeal shock wave lithotripsy is an outpatient procedure and numbing medicine may be given; ureteroscopy is done in hospital under anaesthesia and the patient usually goes home the same day; and PCNL is done in hospital under anaesthesia and a stay of a few days may be needed. The NHS also says no anaesthetic is needed for extracorporeal shock wave lithotripsy and the patient stays awake. This difference depends on the centre; ask your own team.

Before the procedure

Urine test. The EAU says that before endoscopic procedures that damage the lining of the urethra, a urine culture is needed, and if bacteria grow they are treated before the procedure (strong recommendation). Bacteria without symptoms are usually not treated, and this is one of the exceptions. So if you are asked for a urine test, do give it and make sure the team gets the result. If you have fever, burning when you urinate or chills before the procedure, tell the team at once and do not wait until the day of the operation. How to give a sample is described in the test preparation guide.

Assessment before anaesthesia. The NHS says that in the weeks before an operation you may be asked for blood tests, an ECG, a chest X-ray and a fitness assessment, and you will talk to the anaesthetist. Long-term conditions such as diabetes, high blood pressure and anaemia need to be under control. If you smoke, stopping helps. Dental problems matter too, because the breathing tube can damage teeth.

What to tell the team. Tell them all your medicines (including herbal and over-the-counter), your medical conditions, and any earlier allergic reaction to an anaesthetic or another medicine. Tell them your worries too, for example a fear of needles. If you take a blood thinner, or you are or might be pregnant, be sure to say so in advance. The EAU says these medicines affect the timing and type of procedure, and pregnancy rules out shock wave lithotripsy. Do not stop any medicine you take yourself; the NHS says to follow the team’s advice about continuing or stopping your usual medicines.

Fasting. The NHS says that for several hours before the procedure, as instructed by the team, you should not eat or drink so that your stomach is empty. The exact hour comes from the team and there is no general figure.

Belongings. The NHS says to remove jewellery and piercings and take off nail polish. If you are given a disinfectant shower gel, use it as instructed.

A companion. The NHS says someone must take you home and stay with you for at least 24 hours.

After the procedure

The NHS says the effects of anaesthesia last about 24 hours. During this time, do not drive, cycle, cook, use machinery, smoke or drink alcohol, care alone for a child or dependant, or make important decisions. Common effects of anaesthesia are thirst, drowsiness, a sore throat, shivering, nausea and dizziness, and they usually pass within minutes to hours. Serious complications are rare, including severe allergy and breathing problems.

After ureteroscopy or lithotripsy the urine may turn pink or bloody. RUH says that if a stent is placed, a small amount of blood in the urine is common and improves with drinking more water. If a stent is placed, read the stent and catheter guide. The EAU says a stent is not needed in uncomplicated cases and is considered for people at risk of complications.

Which signs should we tell the team about?

After the procedure, tell the team or an emergency department the same day, and do not wait for the next appointment, if you have:

• Fever or chills, or feeling unwell, along with burning when you urinate or flank pain. RUH says a stent and an underlying illness raise the chance of a urinary infection.
• Pain that is constant and unbearable.
• A marked change in the amount of blood in the urine, or clots that block the urine.
• A complete stop in urine.
• A stent that has moved or fallen out (RUH).
• Confusion, severe drowsiness or difficulty speaking, which the NHS treats as an emergency: call 115 (Iran’s emergency number), or your local emergency number if you are outside Iran, and do not drive yourself.

For other signs, see urgent signs. If anything is unclear during or after the procedure, ask the same team; each centre has its own instructions.

A reminder

This guide is general. The instructions of your centre and team, including fasting, medicines and the time of your next visit, take priority over it.

Two different tubes

A ureteral stent (also called a double-J) is a soft, hollow tube placed inside the ureter, the channel between the kidney and the bladder. RUH writes that in an adult it is 24 to 30 cm long and curled at both ends: the upper end in the kidney and the lower end in the bladder, so that it does not move. Its job is to keep the urine pathway open.

A urinary catheter is a different tube. The NHS says it is a soft tube that carries urine from the bladder to a bag and is placed through the urethra or through a small opening in the lower abdomen. The reasons include blockage (such as an enlarged prostate or a stricture), a weak bladder or nerve damage, emptying the bladder before or after surgery, and giving medicine into the bladder.

Ureteral stents

Why is one placed? RUH says that when the kidney is blocked or might be, for example by a piece of stone, a stricture of the ureter, or after an operation on the ureter, a stent opens the urine pathway temporarily. This matters because pressure behind a blockage damages kidney function over weeks, and stagnant urine can become infected. Sometimes a stent is also placed after surgery to let the ureter heal. The EAU says a stent is not needed after uncomplicated ureteroscopy and is considered for people at risk of complications.

How is it placed and removed? RUH says it is usually done under anaesthesia with a special camera through the urethra, sometimes with the help of X-ray images. Removal is short and is usually done with local anaesthetic gel and a flexible camera. Sometimes a thread is tied to the end of the stent and left hanging out of the urethra, and a nurse can remove the stent by pulling it.

How long does it stay? RUH says that for most patients it is needed for a few weeks to a few months, and a correctly placed stent can stay for up to about six months. A stent is temporary and has to be removed or changed. Your team will tell you how long. Write down the date it is due to be removed or changed. RUH says a long-term stent must be changed every six months. A stent must not be forgotten in the body; if the date comes and you have heard nothing, follow it up yourself.

What feels normal? RUH says most patients are aware of the stent most of the time. These are common: frequent urination, urgent urination, a small amount of blood in the urine (which improves with drinking more), a feeling that the bladder is not empty (RUH says to pass urine every 2 to 3 hours if you can), and sometimes, especially in women and when there is a thread, leaking urine. Pain or discomfort in the bladder and flank, and sometimes the groin, urethra or genital area, is also possible, felt more after activity and after urinating. RUH writes that about 20 to 70 percent of patients have one of these effects, it is not possible to predict who will feel what, and some symptoms (pain when urinating, and blood) may improve with time. The effects go away after the stent is removed. If the frequency and urgency are very bothersome, tell your doctor. The EAU says a group of medicines called alpha-blockers can reduce stent-related symptoms, but the choice is your doctor’s.

Activity. RUH says work, exercise, travel and sex are not forbidden, as long as your underlying condition and general health allow. With a stent you may feel more tired and have more blood in the urine after strenuous activity. If you have a thread outside, sex may be harder and care is needed so the thread is not pulled.

Fluids. RUH says to drink at least 1.5 to 2 litres of fluid a day, mostly water, unless your doctor has limited your fluids. This lowers the risk of infection and reduces blood in the urine. Take painkillers only as your doctor advises.

Urinary catheters

The NHS describes two types. An intermittent catheter is placed temporarily and removed after the bladder is emptied. An indwelling catheter is held in the bladder with a small balloon and stays for days to weeks; it is more convenient but has a higher infection risk. A little discomfort is normal, and people who have a catheter for a long time usually get used to it. The NHS says that with proper care, work, exercise, swimming and sex are possible, and the bag can be hidden under clothes. Long-term patients are taught detailed care before discharge: getting supplies, lowering the risk of infection, recognising a problem and when to seek advice.

Possible problems, according to the NHS: urinary infection (the most important risk, which grows the longer the catheter stays), bladder spasms, leaking, blockage and damage to the urethra. The NHS says a long-term catheter should stay only as long as it is needed, and the time for removal and changing depends on the type of catheter and its reason, which your care team will tell you. On its urinary infection page the NHS also says a person who has a catheter and develops signs of infection should get an urgent appointment with a doctor. The patient support form lists home nursing services, including changing a catheter; the details are on the support page.

What should we report the same day?

RUH says to contact your doctor or the hospital if:

• You have persistent, unbearable pain.
• You have signs of infection: fever, burning when you urinate or pain in the kidney or bladder, and feeling unwell. RUH says an infection usually needs antibiotic treatment, and the NHS also asks for an urgent appointment for a very high or very low temperature, chills, back pain under the ribs or blood in the urine. If you cannot reach the team, go to an emergency department with fever or chills.
• The stent has moved or fallen out. RUH says to go to an emergency department.
• The amount of blood in the urine has changed markedly.
• With a catheter: any sign the team told you about at discharge; the NHS says to follow your own discharge instructions. If the bag stays empty and your abdomen becomes swollen and painful, it is as urgent as a complete stop in urine.

If you become confused or drowsy, or speaking becomes hard, the NHS treats it as an emergency: call 115 (Iran’s emergency number), or your local emergency number if you are outside Iran, and do not drive yourself. For the full list, see urgent signs.

A reminder

This guide is drawn from several general sources, and the instructions of the team that placed your stent or catheter take priority. Do not touch your stent or catheter or remove it on your own.

A general rule

Every lab or imaging centre has its own instructions, and theirs take priority over this guide. Where the sources differ, we say so, so you can see why you should ask your own centre. Do not stop any medicine you take in order to prepare; if that is needed, your doctor will say so.

Urine sample (mid-stream)

Oxford University Hospitals explain that a mid-stream sample is the middle part of the urine stream. Urine is normally sterile, and bacteria in the sample can be a sign of infection. Your doctor reads this together with your symptoms, because bacteria without symptoms do not always mean an infection. The first part of the stream may be contaminated with bacteria from the skin, which is why the middle of the stream is wanted. It can be done at any time of day unless your doctor says otherwise.

The steps, according to the same leaflet:

1. Label the container: name, date of birth, and the date and time of the sample.
2. Clean the area first. Men: pull back the foreskin and wipe the tip of the penis. Women: hold the outer lips apart and wipe from front to back.
3. Take off the lid and do not touch the rim or the inside of the container or lid.
4. Start to urinate, and after a second or two, without stopping the stream, hold the container in the stream.
5. Pass the rest of the urine into the toilet.
6. Close the lid tightly, dry the outside of the container, and put it in the bag.
7. Wash your hands with warm water and soap.

The leaflet says that if you cannot fill the container directly, you can use a clean container rinsed in boiling water and then pour the urine into the sterile container. The sample should be handed in at the named centre the same day. The sources do not agree on delivery time and storage, so ask your lab how many hours and at what temperature. If you are having a period, blood may contaminate the sample; tell the lab.

PSA test

• Abstaining. The NHS says not to ejaculate, exercise or cycle for 48 hours before the test, and not to have anal intercourse. MedlinePlus says to avoid sex and masturbation for 24 hours. Your own centre can settle the difference; if the lab has not given another figure, keeping to 48 hours is the more cautious choice.
• Urinary infection. The NHS says to wait 4 to 6 weeks after a urinary infection has cleared. The EAU writes that infections can raise PSA very high and sometimes take up to a year to return to baseline.
• A recent biopsy or procedure. The EAU says to wait at least one month after a prostate biopsy.
• Medicines. MedlinePlus says to tell them all your medicines and not to stop them. The EAU says medicines that shrink the prostate roughly halve the PSA; be sure to say if you take one, so the number is interpreted correctly.
• Rectal examination. The EAU writes that a rectal examination does not change PSA.
• Repeating. The EAU says that if the value is high, repeating it in the same lab with the same method, under the same conditions, makes results more comparable. The NHS says the result usually takes 1 to 2 weeks.

What the result means is in the article PSA explained.

Semen analysis

• Time since last ejaculation. MedlinePlus says to avoid ejaculation for about 2 to 7 days before the sample so that the sperm count is at its highest; follow the lab’s instructions.
• Giving the sample. This is usually done at the lab in a private room by masturbating into a sterile container. Urinate beforehand and wash your hands and penis. Do not touch the inside of the container, do not use lubricant or saliva, and collect all the fluid (MedlinePlus).
• A home sample. If the lab allows it, a collection kit must reach the lab within one hour at room temperature. A special sample condom must arrive near body temperature and within 30 to 60 minutes. Home self-test kits give less information and do not replace a lab analysis.
• Repeating. Because the sperm count varies from day to day, MedlinePlus says several samples may be taken over one to two weeks. The EAU says that if the first result is abnormal, at least two analyses in a row are needed, and if it is normal, one is enough.
• Reference. The EAU says the analysis should follow the sixth edition of the WHO manual (2021). Take the numbers to your doctor with the same lab’s report sheet; the reference limits are not the boundary between fertile and infertile.

For what the numbers mean, see the infertility page and the article Semen analysis explained.

Ultrasound

The NHS says an ultrasound uses sound waves, not radiation. It usually takes 10 to 45 minutes, and an external scan is usually painless. For some ultrasounds you need to drink several glasses of water shortly beforehand and not urinate, so the bladder is full. Ask your centre about fasting for an abdominal ultrasound. Remove jewellery and piercings in the area, and you can ask to have someone with you if you wish.

CT

The NHS says it takes 10 to 20 minutes and uses X-rays. The centre may change your diet, medicines or fasting. Be sure to say if you are or might be pregnant, are breastfeeding, take medicines, have asthma, diabetes, kidney disease or thyroid disease, or have allergies (especially to contrast dye). Contrast dye can cause a warm feeling, a metallic taste or a feeling of needing to urinate, and it leaves the body in the urine. You may be asked to stay for up to 30 minutes after the injection. The result usually takes 1 to 2 weeks, and sometimes up to 4 weeks.

A reminder

This guide is general, and your centre’s instructions take priority. If you have an urgent sign, do not wait for test preparation; see urgent signs.

115 is the emergency number in Iran. If you are outside Iran, call your local emergency number. This list is written for quick decisions and does not replace an examination. If you are in doubt, do not wait; call. There are three groups: what is urgent right now, what must be seen the same day, and what needs an earlier appointment than usual.

Call 115 or go to an emergency department, right now

Sudden, severe pain in one testicle. This may be testicular torsion. MedlinePlus says torsion is more common in the first year of life and at the start of puberty, but it also happens in older men, so take it just as seriously in a baby, boy or teenager. The signs are sudden, severe pain in one testicle, sometimes swelling of one side of the scrotum, and nausea or vomiting. The same source says to go to an emergency department rather than an urgent care clinic, so that if surgery is needed it can be done immediately. If surgery is done within 6 hours, most of the testicle can usually be saved; after 6 hours the chance of losing the testicle rises. The EAU also calls testicular torsion an emergency, puts the important window at about 4 to 6 hours from the start of symptoms, and writes that a Doppler ultrasound should not delay intervention. According to the EAU the diagnosis rests mostly on examination, and inflammation of the epididymis (the tube beside the testicle) can look similar. So you cannot wait until morning, and there is nothing you can do yourself. If the pain eases a little, go anyway; easing pain alone does not rule out torsion. Write down the time the pain began.

A painful erection that has lasted more than 4 hours and does not go down. The EAU says this is an emergency, because blood is trapped in the tissue and oxygen is not getting in. Treatment should start within 4 to 6 hours if possible. After 48 to 72 hours, treatment may relieve the erection and the pain but does much less to protect erectile function. There is nothing to be embarrassed about; delay is more dangerous than anything else. If you use medicine or injections for erections, or have sickle cell anaemia, say so there and then; the EAU counts injection of erection-inducing agents and sickle cell anaemia among the known causes. A painless, half-firm erection after a blow to the penis or the area between the scrotum and the anus is not urgent, but it needs to be assessed. If you are not sure which one you have, go to the emergency department.

You cannot pass urine at all. NIDDK says a sudden stop in urine, often with severe pain in the lower abdomen, can be life-threatening and needs to be seen immediately. The NHS also counts this as urgent with an enlarged prostate. The bladder is usually emptied with a catheter. Blood with a clot that has blocked the urethra and stops you urinating is the same situation.

Flank or back pain with fever or chills. Do not leave this until tomorrow, especially if you have a stone or have had one. The EAU says an obstructed kidney with signs of infection, or a complete stop in urine, is a urological emergency: the urinary tract must be drained urgently and definitive stone treatment delayed until the infection settles. For a kidney infection, the NHS counts a very high temperature or one below 36 degrees, chills, pain under the ribs, blood in the urine, vomiting, passing no urine all day, and pregnancy as reasons to get urgent help, and it warns that a kidney infection can lead to sepsis.

Stone-like pain in someone who has only one kidney. The EAU says that with fever or a single kidney, urgent imaging is needed, and it counts a single kidney or blockage of both sides among the reasons for active stone removal. A stone that blocks your only kidney leaves urine no other way out; do not wait.

A sudden injury or swelling of the penis or scrotum. Three situations cannot wait for an appointment. First, a blow to or bending of the erect penis with a cracking sound, pain, the erection going down at once and quick swelling; the EAU describes this as a penile fracture. Second, a foreskin that has been pulled back, will not return, and has left the head of the penis swollen and painful; MedlinePlus says to go to the emergency room. Third, painful swelling of the scrotum or the area between the scrotum and the anus that gets worse quickly with redness, fever or feeling unwell, especially if you have diabetes or weakened defences. The EAU says Fournier’s gangrene is a severe infection that destroys tissue quickly and leads to sepsis, and it needs immediate antibiotics and early surgery.

Confusion, severe drowsiness or difficulty speaking, together with signs of a urinary or kidney infection. The NHS says this is an emergency, and you should not drive yourself.

The same day: emergency department or doctor

If you cannot reach a doctor or your care team the same day, go to an emergency department.

Severe flank pain without fever. The NHS counts severe pain with a kidney stone as a reason to get urgent help. The article Will my stone pass on its own? explains when waiting is not right.

Persistent nausea and vomiting. NIDDK says that if you are vomiting and have become dehydrated, you may need to be admitted for fluids. The NHS also counts vomiting among the urgent signs in a kidney infection. If you cannot keep fluids down or your urine has become very scanty, act the same day.

Blood with clots in the urine. Clots that have not yet blocked the urine also need to be seen the same day. If urinating becomes hard or stops, go to the group above. See also the article Blood in the urine.

Fever after a kidney transplant, or with a stent or catheter. NIDDK says a kidney transplant recipient with a temperature above 100 degrees Fahrenheit (about 37.8 degrees Celsius), discharge from the incision or burning when passing urine should tell the transplant centre right away. RUH says that with a stent, you should tell the team about fever, kidney or bladder pain, burning when you urinate and feeling unwell. Also constant unbearable pain, a stent that has moved or fallen out, or a marked change in the amount of blood in the urine. The NHS says a person who has a catheter and develops signs of infection should get an urgent appointment. Do not leave fever and chills with a stent or catheter until tomorrow. The stent and catheter guide has more detail.

A urinary infection in a man, in pregnancy or in a higher-risk group. The NHS says a man with signs of a urinary infection should get an urgent appointment with a doctor. The same goes for pregnant women, people with diabetes, children aged 15 or under, people aged 65 or over, people with a catheter and people with weakened defences.

An earlier appointment than usual

Blood in the urine without clots and without feeling unwell is not an emergency, but the NHS asks for an urgent appointment for it, even if the amount was small or there was no pain. That means at the first opportunity, not two months away. The same goes for burning when you urinate that does not go away and for repeated urinary infections. Have a lump or swelling in a testicle checked too: the NHS says this sign often has other causes, but if it is testicular cancer, finding it early can make treatment easier. See the page Blood in the urine, recurrent infections and leaking urine and call for an earlier appointment.

Before you reach the emergency department

• If you have pain or fever, do not take medicine on your own that could mask the symptoms; take only what a doctor has told you.
• Take your list of medicines, allergies and conditions with you.
• If you are alone, call, and do not drive yourself.
• Write down the time the symptom started, especially for the testicle and an erection.

A reminder

This list is for awareness and does not replace an examination and an emergency assessment. If a sign worries you and it is not on the list, call anyway.