First-Line Protocol Guide

Before You Refer

At Spokane Urology, we value the trusted relationships we’ve developed with referring providers across the region. Our shared goal is to ensure every patient receives the right level of care at the right time.

This guide highlights common first-line management recommendations for urologic conditions that are often addressed in primary care before referral. It’s intended as a quick reference to support clinical decision-making and simplify the referral process.

If you’ve already completed these steps or are unsure whether a referral is appropriate, please contact us. When you send a referral, be sure to include relevant imaging, lab results, and prior medication history

First-Line Protocols for Common Urologic Conditions

Each section includes general first-line options followed by advanced therapies available through Spokane Urology.

Erectile Dysfunction

First-line management:

  • Check testosterone levels
  • Trial of Sildenafil or Tadalafil

Advanced therapies:

  • Hormone therapy
  • Penile implant
  • Vascular surgery

Incontinence

Symptoms: Leakage triggered by stress (sneeze, cough, exercise) or urgency

First-line management:

  • Pelvic floor physical therapy or Kegel exercises
  • Dietary modifications (reduce caffeine, alcohol, spicy foods)
  • Trial of Oxybutynin or another OAB medication
  • Pessary ring

Advanced therapies:

  • BOTOX® injection
  • InterStim™ neuromodulation
  • Transvaginal sling
  • Urethral bulking agent (Bulkamid®)

Interstitial Cystitis

Symptoms: Bladder pain, dysuria, pelvic discomfort

First-line management:

  • Pelvic floor physical therapy or Kegel exercises
  • Dietary modifications (reduce caffeine, alcohol, spicy foods)
  • OTC anti-inflammatories

Advanced therapies:

  • Cystoscopy and bladder hydrodistention
  • BOTOX® injection

Overactive Bladder

Symptoms: Urinary frequency or urgency

First-line management:

  • Pelvic floor physical therapy or Kegel exercises
  • Dietary modifications
  • Address constipation as a trigger
  • Trial of Oxybutynin or another OAB medication

Advanced therapies:

  • BOTOX® injection
  • InterStim™ neuromodulation
  • Transvaginal sling
  • Urethral bulking agent (Bulkamid®)
  • Percutaneous tibial nerve stimulation (PTNS)

Testicular Pain

First-line management:

  • Supportive underwear or athletic supporter
  • Ice application
  • NSAID trial
  • Testicular ultrasound prior to referral

Advanced therapies:

  • Evaluation for underlying pathology or malignancy

Recurrent Urinary Tract Infections

Symptoms: More than three infections in 12 months

First-line management:

  • Review hygiene and hydration habits
  • Evaluate bowel regularity (constipation or diarrhea)
  • Trial of cranberry supplements, D-mannose, or vaginal estrogen
  • Short-term antibiotic therapy

Advanced therapies:

  • Long-term antibiotic therapy
  • Evaluation for underlying disease or immune compromise

Kidney Stones (Nephrolithiasis)

Symptoms: Flank pain, cloudy urine, urinary frequency, or history of stones

First-line management:

  • Obtain imaging to confirm the presence of stones prior to referral

Advanced therapies:

  • Lithotripsy
  • Ureteroscopy and laser lithotripsy
  • Stone basketing and stent placement
  • Cystolitholapaxy (bladder stone removal)
  • Extracorporeal shockwave lithotripsy (ESWL)
  • Percutaneous nephrolithotomy (PCNL)

Questions or Referrals?

We’re here to help! If you have questions about when to refer a patient or about the advanced therapies available at Spokane Urology, please contact us.