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 -
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- 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 -
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- 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
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- |
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 |
Requires FAA Decision |
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 - |
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 Otherwise - Requires FAA Decision |
Pyelitis or Pyelonephritis |
All |
Submit all pertinent medical information and status report |
If asymptomatic- Otherwise - Requires FAA Decision |
Pyonephrosis |
All |
Submit all pertinent medical information and status report |
Otherwise - Requires FAA Decision |
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 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 - |
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 - |
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 - |
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 - Otherwise - Requires FAA Decision |
Nephrocalcinosis |
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 Otherwise - Requires FAA Decision |
Renal - Multiple episodes or Retained Stones |
All |
Submit all pertinent medical information and status report |
Initial Special Issuance - 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 - 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