GU System : What to Expect at the Flight Physical

Item 41: FAA Policies on the Airman Medical Exam

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide pages 98-108, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

FlightPhysical.com note: Pregnancy Exam and Gender Identity Disorder are posted separately.

FAA NOTE: The pelvic examination is performed only at the applicant's option or if indicated by specific history or physical findings. If a pelvic examination is performed, the results are to be recorded in Item 60 Examiner Comments of FAA Form 8500-8.

I. Code of Federal Regulations

Legal References: 14 CFR 67.113(b)(c), 67.213(b)(c), 67.313(b)(c),

Legal Extract (Applies to All Classes):

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds -
1. Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
2. May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment involved, finds -
1. Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
2. May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

II. Examination Techniques

The Examiner should observe for discharge, inflammation, skin lesions, scars, strictures, tumors, and secondary sexual characteristics. Palpation for masses and areas of tenderness should be performed. The pelvic examination is performed only at the applicant's option or if indicated by specific history or physical findings. If a pelvic examination is performed, the results are to be recorded in Item 60 Examiner Comments of FAA Form 8500- 8. Disorders such as sterility and menstrual irregularity are not usually of importance in qualification for medical certification.

Specialty evaluations may be indicated by history or by physical findings on the routine examination. A personal history of urinary symptoms is important; such as:

Pain or burning upon urination
Dribbling or Incontinence
Polyuria, frequency or nocturia
Hematuria, pyuria or glycosuria

Special procedures for evaluation of the G-U system should best be left to the discretion of an urologist, nephrologist, or gynecologist.

III. Aerospace Medical Disposition

See Item 48 General Systemic, for details concerning diabetes and Item 57 Urine Test, for other information related to the examination of urine).

FlightPhysical.com note: Pregnancy and Gender Identity Disorder are posted separately.

FAA Remark: A history of recent or significant hematuria requires further evaluation.

The following table lists the most common genitourinary (G-U system) conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the Regional Flight Surgeon. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

FAA Aerospace Medical Disposition Grid for
Item 41. Genitourinary System

Item 41. G-U System Evaluation
General Genitourinary Disorders (Conditions Affecting Your Reproductive and Urinary Systems)
G-U DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Congenital lesions of the kidney	All	Submit all pertinent medical information and status report	If the applicant has an ectopic, horseshoe kidney, unilateral agenesis, hypoplastic, or dysplastic and is asymptomatic- AME may issue the Certificate Otherwise - Requires FAA Decision
Cystostomy and Neurogenic bladder	All	Requires evaluation, report must include etiology, clinical manifestation and treatment plan	Requires FAA Decision
Renal Dialysis	All	Submit a current status report, all pertinent medical reports to include etiology, clinical manifestation, BUN, Ca, PO₄, Creatinine, electrolytes, and treatment plan	Requires FAA Decision
Renal Transplant	All	See Renal Transplant Protocol	Requires FAA Decision

Item 41. G-U System: Inflammatory Conditions
Nephritis and Inflammatory Conditions of G-U System
G-U DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Acute (Nephritis)	All	Submit all pertinent medical information and status report	If > 3 mos. ago, resolved, no sequela, or indication of reoccurrence - - AME may issue the Certificate Otherwise - Requires FAA Decision
Chronic (Nephritis)	All	Submit all pertinent medical information and status report	Requires FAA Decision
Nephrosis	All	Submit all pertinent medical information and status report	Requires FAA Decision
Polycystic Kidney Disease	All	Submit all pertinent medical information and status report	If renal function is normal and no hypertension - Issue Otherwise - Requires FAA Decision
Pyelitis or Pyelonephritis	All	Submit all pertinent medical information and status report	If asymptomatic- Issue Otherwise - Requires FAA Decision
Pyonephrosis (Infection or pus in the renal collecting system)	All	Submit all pertinent medical information and status report	Otherwise - Requires FAA Decision

Item 41. G-U System: Neoplastic Disorders
Neoplasia of G-U System (Cancerous and Precancerous Conditions Affecting Your Reproductive and Urinary Systems)
G-U CANCER/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
All G-U Cancers when treatment was completed more than 5 years ago and there is no history of metastatic disease. (If less than 5 years, see below.)	All	Interview airman	Currently cancer-free and released from oncology care - Issue and warn for recurrence All others - see below
All G-U cancers when treatment was completed less than 5 years ago or for which there is a history of metastatic disease	All	See specific cancers below for the requirements	See specific cancers below for the disposition
Bladder	All	Submit all pertinent medical records, operative/ pathology reports, current oncological status report, including tumor markers, and any other testing deemed necessary report, include duration of symptoms, name and dosage of drugs and side effects	Initial Special Issuance - Requires FAA Decision Followup Special Issuance's - See AASI Bladder Cancer Protocol
Prostatic Cancer	All	Review a current status report, all pertinent medical reports to include staging, PSA, metastatic workup, and operative report, if applicable, and treatment	For prostate cancer without evidence of extra-capsular disease - Issue and warn for adverse change in disease and extra- capsular spread/metastases. All others require FAA Decision. Submit all evaluation data. Initial Special Issuance - Requires FAA Decision Followup Special Issuances - See AASI Prostate Cancer Protocol
Renal Carcinoma	All	Review all pertinent medical records, operative/pathology reports, current oncological status report, including tumor markers, and any other testing deemed necessary report, include duration of symptoms, name and dosage of drugs and side effects	See Renal Cancer Worksheet below. If airman meets all certification criteria - Issue. All others require FAA decision. Submit all evaluation Data. Initial Special Issuance - Requires FAA Decision Followup Special Issuances - See AASI Renal Carcinoma Protocol
Testicular Carcinoma	All	Review all pertinent medical records, operative/pathology reports, current oncological status report, and any other testing deemed necessary report, include duration of symptoms, name and dosage of drugs and side effects	If treatment is complete without sequela and airman is back to full activities of daily living - Issue. All others require FAA Decision. Submit all evaluation data. Initial Special Issuance - Requires FAA Decision Followup Special Issuances - See AASI Testicular Cancer Protocol

Item 41. G-U: Urinary System
Disorders of the Urinary Tract
G-U DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Hydronephrosis with impaired renal function	All	Submit all pertinent medical information and status report	Requires FAA Decision
Nephrectomy (non-neoplastic)	All	Submit all pertinent medical information and status report	If the remaining kidney function and anatomy is normal, without other systemic disease, hypertension, uremia, infection of the remaining kidney - Issue Otherwise - Requires FAA Decision
Nephrocalcinosis (Kidney Stone)	All	Submit all pertinent medical information and status report	If calculus is not in collecting system or renal pelvis - Issue Otherwise - Requires FAA Decision
Calculus¹ Renal - Single episode	All	Submit all pertinent medical information and status report	If there is no residual calculi and the metabolic workup is negative Issue Otherwise - Requires FAA Decision
Renal - Multiple episodes or Retained Stones	All	Submit all pertinent medical information and status report	Initial Special Issuance - Requires FAA Decision Followup Special Issuance's - See AASI Renal Calculi Protocol
Ureteral or Vesical Stone	All	Single episode and no retained calculi, submit current metabolic evaluation and status report (Ureteral stent is acceptable if functioning without sequela)	If metabolic workup is negative and there is no sequela or retained calculi - Issue Otherwise - Requires FAA Decision

FAA Note¹ Complete studies to determine the possible etiology and prognosis are essential to favorable FAA consideration. Determining factors include site and location of the stones, complications such as compromise in renal function, repeated bouts of kidney infection, and need for therapy. Any underlying disease will be considered. The likelihood of sudden incapacitating symptoms is of primary concern. Report of imaging studies (KUB, IVP, or spiral CT) must be submitted in order to conclude that there are no residual or retained calculi.

A history of recent or significant hematuria requires further evaluation.

FlightPhysical.com reminder: Pregnancy and Gender Identity Disorder are posted separately.

This page discussed the GU System section of the Fight Physical Examination required of pilots.

Reminder: use FlightPhysical.com to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now