The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the genitourinary system.
MED.B.035 Genitourinary System
(a) Applicants shall not possess any functional or structural disease of the renal or genitourinary system or its adnexa which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).
(a) Abnormal urinalysis Investigation is required if there is any abnormal finding on urinalysis.
Please note revised terminology for haematuria: now called ‘visible’ and ‘non-visible’ (otherwise referred to as ‘microscopic’ or ‘dipstick positive’ haematuria). Urine dipstick of a freshly voided urine sample containing no preservative is considered a sensitive means of detecting the presence of haematuria.
Routine microscopy for the confirmation of dipstick positive haematuria is not necessary.
SIGNIFICANT HAEMATURIA is defined as:
1. Any single episode of visible haematuria
2. Any single episode of symptomatic non visible haematuria (in the absence of a urinary tract infection (UTI) or other transient cause)
3. Persistent asymptomatic non visible haematuria (in the absence of UTI or other transient cause). ‘Persistent’ is defined as: 2 out of 3 dipsticks positive for non visible haematuria.
NB: Trace haematuria can be considered as negative although not in the presence of significant proteinuria (see below).
Trace proteinurea is acceptable except in the presence of trace haematuria. When trace proteinuria and trace haematuria are both present, a repeat test is indicated. (Note: 24 hour protein collection for the assessment of proteinuria is no longer recommended). Urine protein:creatinine ratio (PCR) or albumin:creatinine ratio (ACR) is preferred. ACR has the greater sensitivity.
SIGNIFICANT PROTEINURIA is defined as: ACR>30 or PCR>50
Abnormal Urinalysis ( PDF) flow chart
Acceptable Means of Compliance
(c) Applicants with any sequela of disease or surgical procedures on the kidneys or the urinary tract likely to cause incapacitation, in particular any obstruction due to stricture or compression shall be assessed as unfit.
(b) Renal disease
(1) Applicants presenting with any signs of renal disease should be assessed as unfit. A fit assessment may be considered if blood pressure is satisfactory and renal function is acceptable.
(2) The requirement for dialysis is disqualifying.
Applicants are requested to submit an annual renal review to confirm blood pressure level and no evidence of proteinuria or impaired renal function. A creatinine clearance below 20ml/min is unacceptable for medical certification. If the review is acceptable, the applicant can be assessed as fit for unrestricted certification.
(d) Applicants with a genitourinary disorder, such as: (1) renal disease;
(a) Renal disease
Applicants presenting with renal disease may be assessed as fit if blood pressure is satisfactory and renal function is acceptable. The requirement for dialysis is disqualifying.
Applicants require regular renal review. In the absence of nephrotic syndrome and its associated thrombotic potential, and in the absence of uncontrolled hypertension, unrestricted certification may be permitted. A creatinine clearance below 20ml/min is unacceptable for medical certification. An albumin level below 35g/l is also disqualifying.
The diagnosis of autosomal dominant polycystic kidney disease requires an OML for class 1 certificate holders. Berry aneurysms need to be excluded by means of Magnetic Resonance Angiography and cardiac valve disease (including aortic root dilatation) by means of an echocardiogram. Abdominal aortic aneurysm also needs to be excluded.
Medication for benign prostatic hypertrophy
Medication for the treatment of bladder instability
Phosphodiesterase Type 5 (PDE5) inhibitors
The main aeromedical concerns are the side effect profile of these drugs which includes colour vision changes in the blue/green and purple spectrum and sudden hearing loss.
* Other trade names are used outside the UK
Notes for pilots:
1) You should discuss the appropriate dose with your GP/AME.
2) PDE5 inhibitors should never be taken in conjunction with any other medication without first discussing potential interactions with your GP/AME.
3) Choose an extended off duty period to try the medication for the first time in case of side effects.
4) Side effects that are important for flying include changes in blood pressure, visual disturbance including a change in colour vision, headaches, musculoskeletal pain and a sustained erectile effect with the potential for distraction from the flying task.
5) You should not obtain this medication other than by prescription to ensure product quality. The contents of medication obtained in other ways, in particular over the internet, cannot be assured.
12 hours should elapse after use before flying/controlling.
(2) one or more urinary calculi, or a history of renal colic; may be assessed as fit subject to satisfactory renal/urological evaluation.
Renal Stones ( PDF) flow chart
(d) Renal/Urological surgery
(1) Applicants who have undergone a major surgical operation on the urinary tract or the urinary apparatus involving a total or partial excision or a diversion of any of its organs should be assessed as unfit for a minimum period of three months or until such time as the effects of the operation are no longer likely to cause incapacity in flight. After other urological surgery, a fit assessment may be considered if the applicant is completely asymptomatic and there is minimal risk of secondary complication or recurrence.
(2) An applicant with compensated nephrectomy without hypertension or uraemia may be considered for a fit assessment.
(3) Applicants who have undergone renal transplantation may be considered for a fit assessment if it is fully compensated and tolerated with only minimal immunosuppressive therapy after at least 12 months. Applicants may be assessed as fit with a multi-pilot limitation.
(4) Applicants who have undergone total cystectomy may be considered for a fit assessment if there is satisfactory urinary function, no infection and no recurrence of primary pathology. Applicants may be assessed as fit with a multi-pilot limitation.
Applicants who have undergone a renal transplant are assessed as unfit. Medical certification can be considered 12 months post-transplant. Renal function must be stable with no underlying systemic disorder that is likely to cause sudden change and blood pressure must be within normal limits. The use of approved anti-hypertensive drugs is permitted. Any steroid dosage must be below 10mg/day. Levels of anti-rejection drugs must be within therapeutic range to minimise side effects. Cardiovascular risk must be assessed by a cardiologist to include an exercise (stress) ECG. To maintain certification, applicants are required to provide an annual renal report. Class 1 holders also require an annual cardiology assessment, including an exercise ECG. The Class 1 certificate will be restricted with OML.
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