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investigated and their condition found unlikely to interfere with the safe exercise of their licence and rating
privileges.
6.3.2.18.1 Urine examination shall form part of the medical examination and abnormalities shall be
adequately investigated.
6.3.2.19 Applicants with sequelae of disease of or surgical procedures on the kidneys or the genito-urinary
tract, in particular obstructions due to stricture or compression, shall be assessed as unfit unless the applicant’s
condition has been investigated and evaluated in accordance with best medical practice and is assessed not
likely to interfere with the safe exercise of the applicant’s licence or rating privileges.
6.3.2.19.1 Applicants who have undergone nephrectomy shall be assessed as unfit unless the condition is
well compensated.
Based on these requirements, an applicant should not be assessed as fit when signs or symptoms of
urological or genitourinary disease are present that might interfere with flight safety. Any transient
condition of the urinary system should be considered a decrease in medical fitness until recovery. These
statements are consistent with the general provisions of Annex 1, paragraph 6.2.2, which state that an
applicant for any class of Medical Assessment shall be required to be free from any abnormality,
disability, sequelae from operation, etc. “such as would entail a degree of functional incapacity which is
likely to interfere with the safe operation of an aircraft or with the safe performance of duties.”
The urine should not contain any pathological element. Proteinuria should always be an indication for
additional medical investigation, but need not be disqualifying for aviation duties. Further discussion of
proteinuria, and specifically albuminuria, is found in the nephrology section of this chapter.
Sequelae of disease or surgical procedures on the kidneys and urinary tract, liable to cause sudden
incapacitation are disqualifying for aviation duties. The examiner should seek urological consultation for
any history of major surgery involving a partial or total excision or diversion of a urinary system organ in
order to assess the condition’s propensity for sudden incapacitation. Obviously, a degree of interpretation
and evaluation must be exercised by the medical examiner and the medical assessor, often in
collaboration with a consultant. Not only medical but also environmental and operational factors should
be taken into consideration for the overall assessment of an applicant’s medical fitness.
In this chapter, the aeromedical concerns commonly associated with genitourinary disease will be
reviewed. In particular, the following conditions will be considered with respect to the disease process,
diagnosis and treatment, and aeromedical implications and disposition:
Renal calculus disease
Haematuria of urological aetiology
Incontinence
Urological infection
Renal cystic disease
ICAO Preliminary Unedited Version — November 2009 III-6-2
Scrotal problems
Benign prostatic hyperplasia and hypertrophy
Urinary malignancy
Urology
Urology is the discipline that specializes in the surgical and medical care of the urinary system in females
and genitourinary system in males. The genitourinary system is multifaceted in that vascular, hormonal,
barometric, and traumatic perturbations have significant influences on the overall function of its organs.
From renal calculus disease to malignant transformation, the genitourinary system may have multiple
diagnoses than can affect the pilot.
RENAL CALCULUS DISEASE
Overview
Urinary calculi can arise from anywhere along the urinary tract, with clinical manifestations varying with
size, configuration, nature, and location of calculi. Small stones (<5 mm) with smooth contours can be
expected to pass spontaneously, albeit with potentially incapacitating symptoms such as severe pain,
nausea, profuse sweating (diaphoresis), or shock, all of which are clearly incompatible with safe flying.
Larger stones typically require surgical intervention.
Clinical features
Renal calculus disease can be identified in many age groups. The incidence of upper urinary tract stones
in aircrew appears, however, to be highest during the fourth and fifth decades. Symptoms may be absent
or may range from the negligible to the most excruciating pain. The attack can develop slowly and
steadily or become suddenly incapacitating. Renal colic commonly arises gradually with flank,
abdominal, back or groin pain. Although an episode that proceeds slowly may be recognized by those
who have previously experienced renal colic, a rapid onset may lead to incapacitation during flight.
Renal pain is caused by acute distension of the renal capsule, resulting in focal symptoms at the ipsilateral
　
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