Urology

Urology Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following specialist medicines are approved for prescribing by or on the recommendation of a prescribing Urology Specialist or Consultant Urological surgeon:

TAF SECTION	MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
7.4.1 7.4.3	Tamsulosin m/r capsules	To enhance expulsion of ureteral stones (Medical expulsive therapy (MET) (unlicensed use ‘off-label’)		European Association of Urology Guidelines on Urolithiasis
7.4.2	Botulinum toxin type A (Botox^®)	Urinary incontinence in adults with neurogenic detrusor overactivity due to subcervical spinal cord injury or multiple sclerosis, who are not adequately managed with anticholinergics; patients should be willing and able to catheterise if required.
7.4.4	Mitomycin bladder instillation (Mitomycin C Kyowa^® 40mg vial and Mito-In^® device)	Recurrent superficial bladder tumours. Adjunct to TURBT.		See SIGN 85 Management of transitional cell carcinoma of the bladder Exophytic bladder tumour protocol Mitomycin prescription form for single dose post TURBT
	BCG (bacillus calmette-guérin) bladder instillation (ImmuCyst^®) Note: due to supply problems alternatives (possibly unlicensed preparations) may require to be used.	Primary high grade bladder carcinoma		Exophytic bladder tumour protocol Isolated bladder carcinoma in situ protocol See SIGN 85 Management of transitional cell carcinoma of the bladder BCG (ImmuCyst^®) prescription form
	Sodium chondroitin sulfate 2% bladder instillation (Uracyst^®) (medical device)	Chronic interstitial cystitis. First line choice.
	Sodium hyaluronate 40mg/50mL bladder instillation (Cystistat^®) (medical device)	Chronic interstitial cystitis. Second line choice.
	Sodium hyaluronate 800mg/50mL & Sodium chondroitin sulphate 1g/50mL (2%) bladder instillation (iAluRil^®) (medical device)	Chronic interstitial cystitis. Alternative to Cystistat.
	Pentosan polysulphate sodium 100mg capsules (Elmiron^®) (unlicensed)	Chronic interstitial cystitis after other treatments have been tried. Review after 3 months.		Oral Pentosan for Interstitial Cystitis Review
7.4.5	Sildenafil	Severe distress as a result of erectile dysfunction (prescribed by GP on specialist advice – see pathway for details).		Urology Pathway for Erectile Dysfunction
	Tadalafil	Severe distress as a result of erectile dysfunction (prescribed by GP on specialist advice – see pathway for details).		Urology Pathway for Erectile Dysfunction
	Alprostadil: by urethral application (MUSE^®); by intracavernosal injection (Caverject^® Dual Chamber, Viridal^® Duo)	Erectile dysfunction (after specialist consultation and initiation; self-administration following appropriate training).
	Terbutaline 5mg tablets (unlicensed use 'off-label')	Priapism during dosage titration with alprostadil.
8.3.4.2	Bicalutamide	Monotherapy in locally advanced prostate cancer or in combination with gonadorelin analogue therapy in advanced prostate cancer.		Prostate cancer protocol
	Cyproterone acetate	Prevention of flare with initial gonadorelin analogue therapy, long-term palliative therapy, hot flushes with gonadorelin analogue therapy.
	Triptorelin m/r injection (as acetate 11.25mg vial) or (as pamoate 22.5mg vial) (Decapeptyl^® SR)	First choice. Androgen depletion in prostate cancer.
	Goserelin 10.8mg implant (Zoladex^® LA)	Androgen depletion in prostate cancer where a subcutaneous depot is preferable.
	Degarelix (Firmagon^®▼)	Hormone naïve metastatic prostate cancer patients with PSA>50 who have severe bone pain, spinal cord compression, or other serious complications of metastatic disease and who need rapid reduction of testosterone levels.		Note that short-term treatment with anti-androgen is not required. Prostate cancer protocol
NHS Tayside Guide to Antibiotic Use	Temocillin	Urinary tract infections requiring IV therapy caused by extended spectrum beta-lactamase (ESBL) producing organisms. 2^nd line in complicated UTI.		Alert Antibiotic Guidelines Antibiotic Dosages
NHS Tayside Guide to Antibiotic Use	Fosfomycin (unlicensed)	Urinary tract infections caused by ESBL producing organisms presenting in the community.		Guidance for Management of Extended Spectrum Beta Lactamase (ESBL) Urinary Tract Infections Presenting in the Community
Tayside Urology – Antibiotic prophylaxis – TRUS biopsy	Ciprofloxacin tablets	Prior to needle biopsy of prostate (unlicensed use ‘off-label’).		Ciprofloxacin prior to prostate biopsy prescription form

	May be prescribed by Hospital Specialists only
	May be prescribed in General Practice under the direction of a Specialist

The following medicines often prescribed by Urology Specialists may initiated by GPs or non-specialists. These medicines are included here for information. For further information refer to the Tayside Area Formulary sections 7.4.1, 7.4.2, 7.4.3, 7.4.4, 7.4.5, the NHS Tayside Guide to Antibiotic Use and the Urology website protocols.

TAF SECTION	MEDICINE	SUMMARY OF INDICATION	PROTOCOL
7.4.1	Tamsulosin m/r capsules	Bladder outflow obstruction.	Tayside Urology Guidance - Lower Urinary Tract Symptoms
	Alfuzosin m/r tablets
	Doxazosin standard release tablets
	Finasteride 5mg tablets	Benign prostatic enlargement.	Tayside Urology Guidance - Lower Urinary Tract Symptoms
7.4.2	Oxybutynin	Urinary frequency (in the absence of outflow obstruction), urgency and incontinence.	Tayside Urology Guidance - Urinary Incontinence SIGN Guideline No. 79
	Solifenacin
	Tolterodine m/r capsules
7.4.3	Diclofenac 100mg suppositories, intramuscular injection 75mg/3mL	Ureteric colic.	European Association of Urology Guidelines on Urolithiasis
7.4.4	Sodium chloride 0.9% urotainer	Bladder instillation.
7.4.5	Sildenafil	Erectile dysfunction (for NHS prescribing: in men who meet the medical eligibility criteria – see local guidance for further details)	Tayside Urology Guidance
7.4.5	Tadalafil		Tayside Urology Guidance

For further information on Tayside Urology Services, including referral guidance and links to local, national and international guidance see the NHS Tayside Urology website (NHS Tayside Staffnet intranet link only). Click on Urology Referral Guidance or Urology Department Information.