This guide is written for the advanced practice provider (NP or PA) new to urology at New Jersey Urology. It assumes strong general clinical training but little urology-specific background.
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New APP welcome · New Jersey
Welcome to New Jersey Urology
New Jersey Urology
New Jersey Urology serves patients through more than 20 locations, an ambulatory surgery center, affiliated hospitals, cancer and advanced-therapy centers, and a broad diagnostic and research network. APPs make that scale personal through dependable assessment, clear counseling, timely escalation, and reliable follow-up.
Locations
More than 20 medical offices across central and southern New Jersey and Bucks County, Pennsylvania, plus specialty cancer and advanced-treatment centers.
ASC / surgery
The network includes an ambulatory surgery center, hospital affiliations with robotics programs, and a multi-site outpatient interventional-radiology expansion announced for 2026.
Integrated resources
More than 50 specialties and subspecialties, specialized cancer clinics, radiation, imaging, lab, in-office dispensing, hospital affiliations, and clinical research.
Practice philosophy
Who cares more? We do.
Care is an action, not a slogan. Go the extra mile, make the patient feel that you care, and use every appropriate resource to move the patient toward the best achievable outcome.
01
Go the extra mile
Anticipate the next obstacle, close the loop, and do not pass a solvable problem to someone else.
02
Show that you care
Listen closely, explain and draw the plan, respond when patients call, and make sure the next step is scheduled.
03
Be innovative and creative
Use technology, colleagues, and thoughtful problem-solving to find a safe path forward within evidence, privileges, and policy.
04
Create a great outcome
We cannot promise a cure, but we can always improve the outcome: relief, clarity, dignity, a safe plan, timely escalation, or a follow-up that does not get missed.
Didactics
Shared across all locations
1.1 Your APP role at New Jersey Urology
APPs at New Jersey Urology provide office and hospital-based care across a network of more than 20 locations. The role centers on dependable assessment, individualized counseling, patient education, timely escalation, and coordination with cancer centers, the ambulatory surgery center, affiliated hospitals, imaging, laboratory, medication-dispensing, research, and interventional-radiology services.
The standard: arrive prepared, recognize urgency, make a clear plan, use the practice’s full capabilities, communicate with patients and colleagues, and close every result and follow-up loop.
1.2 Your toolkit: IntelligentOne on the MacBook
Neo
Every Advanced APP is
issued a MacBook Neo with IntelligentOne loaded on it. IntelligentOne
is our AI clinical operating system — an intelligence layer that
sits on top of the EMR (no migration, no separate login workflow) and
removes the administrative drag so you can spend your time being a
clinician and proceduralist. Think of it as point-of-care clinical
decision support plus an automation engine, built specifically for
urology.
Instant
pre-visit intelligence: pulls the full record from the EMR —
allergies, meds, labs, imaging, prior procedures, insurance — and
generates a structured clinical summary in seconds, so you walk in
already oriented.
Ambient
AI scribe: records and transcribes the encounter in real time
with urology-grade accuracy and drafts the note (including surgical
indications) for you — documentation stops being the job.
Clinical
decision support and safety net: evaluates every encounter
against clinical rules — allergy interactions, blood-thinner
management before procedures, cardiac-clearance flags,
active-surveillance tracking — surfacing evidence-based
recommendations while you are still with the patient.
Automated
actions and authorization: triggers patient-education delivery,
referral and appeal letters, and prior-authorization checks
(predicting denials before they happen and drafting appeals), all
with staff approval gates.
Patient
communication and translation: medical-grade translation and
SMS/MMS messaging so you can close the loop with patients in their
own language. (The same platform powers our patient-education
library at learn.advancedurology.com.)
Why this matters for you
IntelligentOne is what lets
our APPs practice at the top of license: it absorbs the
documentation and administrative load (practices report 40–60%
less admin burden) so your hours go to patients and procedures —
not paperwork.
Use it as a second set of eyes, not a substitute for
judgment: verify its recommendations, and escalate anything that
does not fit the patient in front of you.
1.3 A dependable clinic workflow
Frame
the visit: new consult, established follow-up, procedure, or acute
problem. This sets your time and documentation expectations.
Review
objective data BEFORE you walk in: urinalysis/culture, PSA trend
(with dates), creatinine/eGFR, prior imaging (read the actual
report, not just the impression), cytology, operative notes, and
pathology. Walking in cold is the most common cause of a wasted
visit.
Get the FULL
urologic history — not just the history of the presenting
complaint. Screen every patient for LUTS, hematuria, incontinence,
sexual function, and PSA screening, whatever they came in for
(Section 1.4).
Do the
focused exam: abdomen/flank (palpable bladder, CVA tenderness),
external genitalia, DRE when indicated, and pelvic exam for female
LUTS/prolapse.
Formulate an
assessment and a shared plan. Name the diagnosis out loud to the
patient in plain language.
Close the
loop: confirm the safety net (what should prompt them to call or
return), who is ordering what, and the follow-up interval. Make sure
the follow-up is scheduled before the patient leaves. Document it.
Complete the
post-visit workflow:
Review the IntelligentOne post-visit analysis. It
evaluates the clinical care against applicable guidelines to help make
sure the patient receives the best care and nothing is missed.
Send the patient the appropriate brochure from
Urology411.com. This internal patient-education tool texts the
brochure directly to the patient.
Send the patient a post-visit summary.
If the patient had a good visit, also send the patient a review
link.
1.4 Take a FULL urologic history on every patient
— every time
This is a core
expectation at New Jersey Urology, and it is one of the easiest ways to
be a great APP rather than an average one. The patient in front of
you came in for a kidney stone. Ask them about their urinary stream
anyway. Ask about nocturia, urgency, and leakage. Ask about
erections. Ask whether they have ever had their PSA checked. Ask
about blood in the urine. Do it even when it is not the reason for
the visit — especially then.
Do not miss a urologic complaint — it
is our job
Screen EVERY patient for the
full urologic review of systems regardless of why they came in:
LUTS (storage, voiding, post-micturition), hematuria,
incontinence, sexual function, and — in men of the appropriate
age — PSA screening and a shared decision-making conversation
(Chapter 8).
Patients do not volunteer
these things. They are embarrassed, they assume leaking or a weak
stream is “just age,” and they will not raise it unless you
do. A man will sit through an entire stone follow-up and never
mention that he gets up five times a night.
We are the urologists. If a
urologic problem walks through our door and leaves undiagnosed
because nobody asked, that is on us — no one else is going to
catch it. A stone visit is a chance to find the BPH, the low
testosterone, the microscopic hematuria, and the prostate cancer.
This is also how a practice grows the right way: by taking
complete care of the patient in front of you.
The core urologic history (LUTS framework)
Lower urinary
tract symptoms (LUTS) divide into storage, voiding, and
post-micturition categories. Naming the category guides your
differential and your treatment. Most patients have a mix — your
job is to identify which component bothers them most, because that is
the one you treat.
BPH/bladder-outlet obstruction, urethral stricture,
hypocontractile (underactive) bladder, neurogenic, prior surgery
Post-micturition
Post-void dribble, sensation of incomplete emptying
Urine retained in the bulbar urethra, high PVR
Always
quantify and screen: — fluid, caffeine and alcohol intake;
nocturia episodes (and whether they fall back asleep); pad use (how
many, how wet); hematuria (gross vs. microscopic); fevers; flank or
suprapubic pain; prior instrumentation, STI, and catheter history;
neurologic disease; diabetes; and the medication list
(antihistamines, decongestants, opioids, anticholinergics, diuretic
timing).
A voiding diary
and a validated symptom score (IPSS for BPH — Chapter 4) turn vague
complaints into trackable numbers. If you do not measure at baseline,
you cannot prove you helped.
Cross-cutting red flags — escalate or
work up promptly
Gross hematuria (visible
blood), especially painless — malignancy until proven otherwise
Fever with flank pain or an
obstructing stone — possible urosepsis, an emergency
Acute inability to urinate
with a painful, distended bladder — acute retention
Acute severe scrotal pain,
especially in an adolescent or young man — torsion until proven
otherwise
New neurologic deficits with
urinary retention or saddle anesthesia — consider cauda equina
An elevated or rapidly
rising PSA — evaluate it (we use PSA, biomarkers, and MRI, not
the DRE, to evaluate for prostate cancer — Chapter 8)
Any solid intratesticular mass
1.5 Interpreting the basics
Urinalysis
Dipstick
blood: reacts to intact RBCs, free hemoglobin, AND myoglobin —
a positive dipstick is not hematuria until microscopy confirms ≥ 3
RBCs/HPF.
Leukocyte
esterase and nitrite: nitrite is specific but insensitive (only
nitrate-reducing organisms — Enterobacteriaceae; Enterococcus and
Staph saprophyticus are nitrite-negative). Pyuria without symptoms
is not an infection.
Casts and
protein: RBC casts, dysmorphic RBCs, or significant proteinuria
point to glomerular disease — that is a nephrology problem, not
ours (Chapter 3).
Post-void residual (PVR)
Measure by
bladder scan after a comfortable, natural void. A single high value
is not a diagnosis — repeat it.
Roughly: <
50–100 mL is normal; 100–200 mL is equivocal; persistently >
300 mL is significant retention and changes management (do not add a
drug that worsens emptying).
Creatinine / eGFR
Always know
the renal function before ordering contrast, prescribing
nitrofurantoin, dosing Hiprex, or planning nephron loss.
New renal
insufficiency in a patient with LUTS should prompt a renal
ultrasound to exclude bilateral hydronephrosis from obstruction.
Clinical Pathway
Click any node to expand
Chapter 1 has no disease logic — it is how an Advanced APP actually runs a day. These four tracks turn it into a workflow: how a visit runs start to finish, the full urologic history you owe every patient, how to read the basic tests, and what the practice can do for you.
A dependable sequence for any urology encounter — new consult, follow-up, procedure, or acute problem.
Select a box to open its teaching details.
Why this is step one
Framing the visit sets your time and documentation expectations before you spend either. A new consult and a stent-check are not the same encounter.
The four frames
New consult — full history, full exam, a real differential
Established follow-up — did the intervention work, and what is the next decision
Acute problem — retention, clot, pain, fever: triage before you settle in
Ch 1.3
Local policy
What it is
IntelligentOne is our AI clinical operating system — an intelligence layer that sits on top of the EMR. No migration, no separate login workflow.
What it does for you
Instant pre-visit intelligence — pulls allergies, meds, labs, imaging, prior procedures and insurance from the EMR and generates a structured clinical summary in seconds
Ambient AI scribe — records and transcribes the encounter in real time with urology-grade accuracy and drafts the note, including surgical indications
Clinical decision support and safety net — checks every encounter against rules: allergy interactions, blood-thinner management before procedures, cardiac-clearance flags, active-surveillance tracking
Automated actions — patient-education delivery, referral and appeal letters, prior-authorization checks that predict denials and draft appeals, all with staff approval gates
Communication — medical-grade translation and SMS/MMS so you can close the loop in the patient's own language
Why this matters for you
IntelligentOne is what lets our APPs practice at the top of license — it absorbs the documentation and administrative load (practices report 40-60% less admin burden) so your hours go to patients and procedures.
Pitfalls
Use it as a second set of eyes, not a substitute for judgment. Verify its recommendations.
Escalate anything that does not fit the patient in front of you.
Ch 1.2
The pre-visit checklist
Urinalysis and culture
PSA trend — with dates, not a single value
Creatinine / eGFR
Prior imaging — read the actual report, not just the impression
Cytology
Operative notes
Pathology
Pitfalls
Reading only the impression line of an imaging report hides the findings that change your plan.
A PSA without dates is not a trend and cannot be interpreted.
Ch 1.3
The expectation
This is a core expectation at New Jersey Urology, and it is one of the easiest ways to be a great APP rather than an average one. The patient came in for a kidney stone — ask about the stream anyway.
Where the detail lives
The full framework — storage vs. voiding vs. post-micturition, what to quantify, and the cross-cutting red flags — is the Full urologic history track of this pathway.
Ch 1.4
What to examine
Abdomen and flank — palpable bladder, CVA tenderness
External genitalia
DRE only when indicated for a non-sizing assessment, such as tenderness in suspected acute prostatitis; use ultrasound to measure prostate volume (Ch 4)
Pelvic exam for female LUTS or prolapse
Ch 1.3
What did the history and exam turn up?
Time-critical
Escalate now
Gross hematuria, especially painless — malignancy until proven otherwise
Fever with flank pain or an obstructing stone — possible urosepsis, an emergency
Acute inability to urinate with a painful, distended bladder — acute retention
Acute severe scrotal pain, especially in an adolescent or young man — torsion until proven otherwise
New neurologic deficits with urinary retention or saddle anesthesia — consider cauda equina
An elevated or rapidly rising PSA — evaluate it (we use PSA, biomarkers and MRI, not the DRE — Ch 8)
Any solid intratesticular mass
Ch 1.4
Reach for
Urinalysis with microscopy (and culture if indicated)
Post-void residual by bladder scan
A voiding diary and a validated symptom score — IPSS for BPH (Ch 4)
Imaging we own in-house: renal, scrotal and penile ultrasound at every location
Why measure
If you do not measure at baseline, you cannot prove you helped.
Ch 1.4
Local policy
Our culture
You can always ask anyone for help. Every physician and every APP here wants to help you, and no one will think less of you for asking.
Curbside a colleague, call the on-call urologist, grab whoever is in the hallway.
Never sit on uncertainty.
The one unforgivable error
The only unforgivable error in this specialty is the one you sat on quietly. Torsion, sepsis, and cord compression punish delay, not questions.
Ch 1 — opening
What good looks like
Say the diagnosis in words the patient will repeat to their spouse in the car
Offer the options, not just the one you prefer
Tie the plan to the symptom that bothers them most — that is the one you treat
our practice care philosophy
Fix the problem definitively with minimally invasive technology rather than manage it indefinitely with medication — and steer away from drugs (like anticholinergics) whose long-term risks outweigh their benefit.
Ch 1.3
Three things, said out loud
The safety net — exactly what should prompt them to call or return
Who is ordering what — you, the physician, or an outside office
The follow-up interval — make sure the follow-up is scheduled before the patient leaves
Then document it
Let the ambient scribe draft the note, then read it. Documentation stops being the job — it does not stop being your responsibility.
Ch 1.3
The three required actions
Review the IntelligentOne post-visit analysis — it evaluates the clinical care against applicable guidelines to help make sure the patient receives the best care and nothing is missed
Send the appropriate brochure from Urology411.com — the internal tool texts it directly to the patient
Send the patient a post-visit summary
When the visit went well
Also send the patient a review link.
Ch 1.3
Local policy
Our position
We control quality, turnaround, and the patient experience best when the imaging, the procedure, the infusion, and the pharmacy are ours.
We deliberately avoid sending patients out for imaging or to hospitals whenever we can do it in-house.
We accept all major insurances — access should rarely be the barrier to getting a patient treated.
Know what we have and where
It determines whether you can keep a study in-house or have to send it out (Ch 21). See the Know the practice track.
Ch 1 — About New Jersey Urology
Screen EVERY patient for the full urologic review of systems, regardless of why they came in.
Select a box to open its teaching details.
Why patients will not raise it
They are embarrassed.
They assume leaking or a weak stream is "just age."
They will not raise it unless you do. A man will sit through an entire stone follow-up and never mention that he gets up five times a night.
Whose job it is
We are the urologists. If a urologic problem walks through our door and leaves undiagnosed because nobody asked, that is on us — no one else is going to catch it. This is also how a practice grows the right way: by taking complete care of the patient in front of you.
Ch 1.4
Why the category matters
Most patients have a mix. Your job is to identify which component bothers them most, because that is the one you treat.
Ch 1.4 — LUTS framework
Which LUTS category dominates?
Typical drivers
OAB
Infection
Stones
Bladder tumor / CIS
Diabetes
CHF
Caffeine
Where it goes
Storage-dominant symptoms route to Chapter 5 (OAB and incontinence) — but exclude infection, hematuria and a high PVR first.
Ch 1.4
Typical drivers
BPH / bladder-outlet obstruction
Urethral stricture
Hypocontractile (underactive) bladder
Neurogenic bladder
Prior surgery
Where it goes
Voiding-dominant symptoms route to Chapter 4 — but a very poor flow in a young man is a stricture until proven otherwise, not BPH.
Ch 1.4
Typical drivers
Urine retained in the bulbar urethra
High PVR
Practical fix
Post-void dribble from bulbar pooling is often solved with milking the urethra and double-voiding, not a drug — check the PVR before you assume retention.
Ch 1.4
Quantify and screen
Fluid, caffeine and alcohol intake
Nocturia episodes — and whether they fall back asleep
Pad use — how many, and how wet
Hematuria — gross vs. microscopic
Fevers; flank or suprapubic pain
Prior instrumentation, STI, and catheter history
Neurologic disease; diabetes
The medication list
Antihistamines
Decongestants
Opioids
Anticholinergics
Diuretic timing — an evening dose is a common, fixable cause of nocturia
Ch 1.4
What to ask
Have you ever seen blood in your urine — even once, even years ago?
Was it visible, or did a doctor find it on a test?
Any clots?
Why it changes everything
Any prior episode of gross hematuria automatically raises the risk tier for future microhematuria evaluation (Ch 3).
Ch 1.4
Incontinence
Leak with cough, laugh, sneeze, lifting — stress
Sudden urge then leak — urgency
Constant dribbling — think overflow or fistula
Pads: how many per day, and how wet
Sexual function
Erections — quality, and whether it changed
Ejaculation — volume, and whether it disappeared (ask before and after any prostate drug or procedure)
Libido — a doorway to low testosterone
Ch 1.4
What to do
Ask whether they have ever had a PSA checked
Have the shared decision-making conversation — do not order silently (Ch 8)
If a PSA exists, put it in date order and look at the trend
Our position
We use PSA, biomarkers and MRI — not the DRE — to evaluate for prostate cancer (Ch 8).
Ch 1.4
Why
A voiding diary and a validated symptom score turn vague complaints into trackable numbers. If you do not measure at baseline, you cannot prove you helped.
Ch 1.4
Time-critical
Escalate or work up promptly
Gross hematuria (visible blood), especially painless — malignancy until proven otherwise
Fever with flank pain or an obstructing stone — possible urosepsis, an emergency
Acute inability to urinate with a painful, distended bladder — acute retention
Acute severe scrotal pain, especially in an adolescent or young man — torsion until proven otherwise
New neurologic deficits with urinary retention or saddle anesthesia — consider cauda equina
An elevated or rapidly rising PSA — evaluate it
Any solid intratesticular mass
Pitfalls
Do not defer a red flag to "next visit" because it was not the reason they came in.
Torsion, sepsis, and cord compression punish delay, not questions — call.
Ch 1.4
Urinalysis, post-void residual, and renal function — the three results you will interpret in almost every visit.
Select a box to open its teaching details.
Order of operations
Confirm the abnormality is real before you build a work-up on it. Dipsticks and single bladder scans both mislead.
Ch 1.5
The threshold
A positive dipstick is not hematuria until microscopy confirms ≥ 3 RBCs/HPF
Pitfalls
Launching a full hematuria work-up off a dipstick alone.
Forgetting that rhabdomyolysis (myoglobin) and hemolysis (free hemoglobin) both turn the pad positive with no red cells present.
Ch 1.5 — urinalysis
What the nitrite pad can and cannot see
Only nitrate-reducing organisms turn it positive — Enterobacteriaceae
Enterococcus and Staph saprophyticus are nitrite-negative
Pitfalls
Pyuria without symptoms is not an infection. Do not reflexively treat it.
These point to glomerular disease — that is a nephrology problem, not ours (Ch 3). Refer rather than proceeding to cystoscopy and upper-tract imaging.
Ch 1.5 — urinalysis
Technique
Scan after a comfortable, natural void — not after a rushed or prompted one
A single high value is not a diagnosis — repeat it
Ch 1.5 — post-void residual
How to read the PVR number
Implication
You have room to treat storage symptoms without worrying about precipitating retention.
Ch 1.5
Implication
Recheck on another day after a natural void. Do not build a management change on one equivocal scan.
Ch 1.5
What changes
Do not add a drug that worsens emptying
Check renal function
Reconsider the diagnosis — obstruction, underactive bladder, or neurogenic disease
Ch 1.5
Always know renal function before
Ordering contrast
Prescribing nitrofurantoin
Dosing Hiprex
Planning nephron loss
Ch 1.5 — creatinine / eGFR
Time-critical
Why
Obstructive uropathy is reversible if you find it. New renal insufficiency plus LUTS should prompt a renal ultrasound to exclude bilateral hydronephrosis from obstruction.
In-house
We have ultrasound (renal, scrotal, penile) at every location — there is no reason to send this out.
Ch 1.5 — creatinine / eGFR
A practical map of New Jersey Urology: more than 20 locations, the surgery and hospital network, cancer and IR services, clinical breadth, and APP care settings.
Select a box to open its teaching details.
Counties in the network
Atlantic, Burlington, Camden, Cumberland, Gloucester, Mercer, Middlesex, Monmouth, and Somerset counties in New Jersey
Bucks County, Pennsylvania
The contact list includes medical offices plus cancer and advanced-therapy centers
New Jersey Urology
Time-critical
Procedure settings
Office-based urologic care and procedures
Ambulatory surgery center for same-day operative care
Affiliated hospitals with robotic programs and admission capability
Outpatient interventional-radiology expansion across multiple New Jersey sites
New Jersey Urology
Local policy
Named specialty sites
Center for Advanced Therapy — Immunotherapy in Cherry Hill
Cherry Hill Cancer Center
Lawrenceville Cancer Center
Radiation therapy, imaging, laboratory, and medication dispensing
Clinical research
New Jersey Urology
Local policy
Care across the network
General urology for men, women, and children
Urologic cancers
Stone disease and BPH
Voiding dysfunction, incontinence, and pelvic health
Advanced technology and clinical research
New Jersey Urology
APP care model
Office evaluation and longitudinal urologic care
Hospital-based assessment and coordination in designated roles
Patient education and individualized counseling
Clear communication and timely escalation
Care plans tailored to the patient's goals and needs