ITEM 41. G-U System

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(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:

II. Examination Techniques (Updated 06/26/2024)

Genitourinary (G-U) includes genital system and urinary system (kidney/bladder/urethra/ureters)

The physical exam does not include a pelvic examination.

Genital exam is not required unless indicated by past medical history (PMH) or symptoms (e.g., masses or areas of tenderness). It may be performed at the discretion of the examiner and applicant.

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).

The following tables list the most common conditions of aeromedical significance and course of action which should be taken by the AME, as defined by any corresponding 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 RFS. In most cases, medical documentation must be submitted for these condition in order to support an issuance of a medical certificate.

GENERAL DISORDERS

All Classes

• CHRONIC KIDNEY DISEASE (CKD)
• All Classes
• (Updated 03/27/2019)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. eGFR 45 to 59	No symptoms or complications and the underlying cause is not disqualifying.	ISSUE Summarize this history in Block 60.
B. eGFR 35 to 44	See CACI worksheet.Single kidney – DO NOT CACI	Follow the CACI – Chronic Kidney Disease Worksheet annotate Block 60.
C. eGFR 34 or lessORSymptoms or complications with any eGFRProteinuria 2+ or higher or ACR is 300 or higherORSingle kidney with eGFR 44 or less	Submit the following to the FAA for review: ☐ Current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam. It should include a detailed summary of the history of the condition, current medications, dosage, and side effects (if any); physical exam findings, results of any testing performed, diagnosis, assessment, plan (prognosis), and follow-up. ☐ It should note if the condition is stable or if additional treatment or dialysis is recommended; ☐ Recent lab (within last 90 days) o Renal function studies(creatinine, BUN and eGFR); o Albumin as dipstick or ACR; and o Hemoglobin and hematocrit ☐ Imaging reports (if performed by treating physician); and ☐ Assessment by treating physician if evaluation is warranted.	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow-up Special Issuance – Will be per the airman’s Authorization Letter
ESRD requiring dialysis or kidney transplant	See table on previous page for more information.	DEFER

Notes: eGFR is a calculated/estimated value. If additional testing shows the actual renal function is higher than the eGFR, this should be stated in the note from the treating physician.

ACR = albumin creatinine ratio

CACI – Chronic Kidney Disease (CKD) Worksheet

(Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST REVIEW

The treating physician’s current, detailed Clinical Progress Note verifies:

eGFR is 35 or higher (Most recent value, must be within the last six (6) months.)

• Albumin on urine dipstick is trace or negative
• OR albumin creatinine ratio (ACR) is 29 or less

Hemoglobin is at least 10 gm/dL AND hematocrit is at least 30%

Current treatment

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Chronic Kidney Disease.

[ ] Has current OR previous SI/AASI but now CACI qualified Chronic Kidney Disease.

[ ] NOT CACI qualified Chronic Kidney Disease. I have deferred. (Submit supporting documents.)

• LOW TESTOSTERONE (LOW T) HYPOGONADISM
• All Classes
• (Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treated with topical testosterone only	If the AME can determine the condition is under control, current medications are acceptable, and no symptoms that would interfere with flight or safety related duties:	ISSUEAnnotate this information in Block 60.
B. Treated with one or more of the following:• Anastrozole• Clomiphene citrate• Human Chorionic Gonadotropin (HCG)• Testosterone (Oral or Injectable)• Testopel• Tamoxifen	See the CACI - Hypogonadism Worksheet.This requires a complete blood count (CBC) lab AND a current, detailed Clinical Progress Note from the treating physician OR a completed Low Testosterone (Low T) Hypogonadism Status SummaryIf the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUE Annotate (elements or findings) in Item 60.Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. All othersORRequires or concurrent treatment with phlebotomy (See Blood Donation page.)Note: Use of enclomiphene citrate is NOT acceptable.	Submit the following for FAA review:1. Low Testosterone (Low T) Hypogonadism Status Summary.ORA current, detailed Clinical Progress Note generated from a clinic visit with the treating urologist, endocrinologist (preferred), or treating physician no more than 90 days prior to the AME exam. It must address all items listed on the Status Summary:1. A detailed summary of the history of the condition with:• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;	DEFER Submit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
	• Prognosis; and Follow-up.2. It must specifically include:• Current medications; and• If there is any history of cardiovascular disease, thromboembolic events, or prostate cancer.3. Lab - CBC performed no more than 90 days before the AME exam.See “Pilot Information – Clinical Progress Note

Low Testosterone (Low T) Hypogonadism Status Summary

(Updated 08/26/2026) Name ______________________________ Birthdate _______________________________

Applicant ID# ___________________________ PI# ____________________________________

Please have your urologist, endocrinologist, or treating physician who manages your Low Testosterone (Low T) Hypogonadism provide the requested information in the space provided or submit a current, detailed Clinical Progress Note addressing each item.

recommended, or are any concerning side effects present? ...............................

Current medications OR attach current therapy (medication and dose):

☐ Anastrozole ☐ Clomiphene citrate (AME must confirm no visual side effects present.) ☐ Human Chorionic Gonadotropin (HCG) ☐ Testosterone (Oral or Injectable) ☐ Testopel ☐ Tamoxifen ☐ Other _____________________________________________________________________

If any “YES*” responses or adverse changes in the condition, submit a current, detailed Clinical Progress Note addressing ALL items.

____________________________________ ________________________ __________________ Endocrinologist, urologist, or physician name Signature Date of evaluation

AME ACTIONS:

NOTE: This Status Summary is NOT required (clinical records may be submitted); however, it will help to streamline and significantly DECREASE FAA review time.

CACI – Low Testosterone (Low T) Hypogonadism Worksheet

(Updated 04/29/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the urologist, endocrinologist, or treating physician no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Hypogonadism. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Hypogonadism.

[ ] NOT CACI qualified Hypogonadism. I have deferred. (Submit supporting documents.)

• INFLAMMATORY CONDITIONS
• All Classes

• KIDNEY STONE(S)
• (NEPHROLITHIASIS, RENAL CALCULI)
• OR RENAL COLIC
• All Classes
• (Updated 06/28/2017)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Most recent event/diagnosis 5 or more years ago.	No symptoms or current problems. Renal function has returned to normal. No ongoing treatment or surveillance needed.	ISSUE Summarize this history in Block 60.
B. Single stone that passed Less than 5 years ago with no complications*	If a single stone passed or is in the bladder with no further problems and imaging (such as a KUB) verifies no retained stones:	ISSUE Summarize this history in Block 60.
C. Multiple or Retained asymptomatic stone(s) Less than 5 years ago with no complications*Note: Use this for incidental findings.	See CACI worksheet	Follow the CACI – Retained Kidney Stone(s) Worksheet. Annotate Block 60
D. All others Complications* Symptomatic Underlying cause for recurrent stones	Submit the following to the FAA for review: ☐ Current, detailed Clinical Progress Note generated from a clinic visit with the treating urologist no more than 90 days before the AME exam with treatment plan and prognosis. ☐ If underlying cause is identified, the status report should include diagnosis, treatment plan, prognosis and adherence to treatment for this condition; ☐ List of medications and side effects (if any); ☐ Operative notes and discharge summary (if applicable);and ☐ Copies of imaging reports and lab (if already performed by treating physician)	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter

*Complications include:

Metabolic evaluations and imaging should be performed as clinically indicated by the treating physician. Acceptable imaging includes KUB, ultrasound, IVP, or CT/MRI as clinically appropriate per the treating physician.

CACI – Retained Kidney Stone(s) Worksheet (Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE CERTIFICATION
• CRITERIA
• The treating physician’s current, detailed Clinical

Progress Note verifies that the condition is:

o Is off pain medication(s);

o Has made a full recovery; and o Has a full release from the surgeon;

[ ] Yes

Is there an underlying cause for stone recurrence? [ ] No

Current or recommended treatment

After a single stone event - if follow up imaging verifies no further stone(s) present, annotate this in Block 60. No further follow up is required unless there is a change in condition.

[ ] None

Supportive treatments such as hydration or medications (such as thiazides, allopurinol, or potassium citrate) to decrease recurrence (with no side effects) are allowed.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Retained Kidney Stone(s). (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Retained Kidney Stone(s).

[ ] NOT CACI qualified Retained Kidney Stone(s). I have deferred. (Submit supporting documents.)

• NEOPLASTIC DISORDERS/CANCER
• BLADDER CANCER
• All Classes
• Updated 08/26/2015

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Non metastatic and treatment completed 5 or more years ago	No recurrence or ongoing treatment:	ISSUE Summarize this history in Block 60.
B. Non metastatic and treatment completed less than 5 years ago	See CACI worksheet.Local recurrence within the bladder only: Follow CACI – Bladder Cancer Worksheet.	Follow the CACI - Bladder Cancer Worksheet. Note in Block 60.
C. Metastatic disease,muscle invasion,orRecurrent disease that has spread outside the bladder	Information that needs to be submitted to the FAA for review:☐ Current, detailed Clinical Progress Note from the treating oncologist describing treatment plan and prognosis; ☐ List of medications with attention to any chemotherapy agents and dates used; ☐ Treatment records including clinic notes or summary letter describing initial staging and treatment course; ☐ Operative notes and discharge summary (if applicable); ☐ Pathology report(s) (if applicable); and ☐ MRI/CT or PET scan reports (In some cases, the actual CDs will be required in DICOM format for FAA review.)	DEFERInitial Issuance - Submit the information to the FAAFollow up Issuance - Will be per the airman’s authorization letter

Note: If the airman is currently on radiation or chemotherapy, the treatment course must be completed before medical certification can be considered.

CACI – Bladder Cancer Worksheet (Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified bladder cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified bladder cancer.

[ ] NOT CACI qualified bladder cancer. I have deferred. (Submit supporting documents.)

• PROSTATE CONDITIONS
• All Classes
• (Updated 08/26/2015)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
Benign Prostatic Hypertrophy (BPH) or elevated PSA	If the airman has findings consistent with uncomplicated BPH with no evidence of prostate cancer:	ISSUE Summarize this history in Block 60

Note: See Pharmaceuticals section for a list of medications usually allowed.

• PROSTATE CANCER
• All Classes
• (Updated 05/31/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Prostate Cancer Non metastatic With treatment completed 5 or more years ago	If NO recurrence or ongoing treatment:	ISSUE Summarize this history in Block 60.
B. Prostate Cancer Non metastatic with treatment completed less than 5 years ago or active surveillance/watchful waiting.	See CACI worksheet.	Follow the CACI - Prostate Cancer Worksheet Note in Block 60.
C. Prostate Cancer With Metastatic diseaseCurrent OR any time in the pastORRecurrence of disease Including a biochemical recurrence (BCR) after prostatectomy	Submit the following for FAA review: ☐ Current, detailed Clinical Progress Note generated from a clinic visit with the treating oncologist no more than 90 days before the AME exam. Status It should describe treatment plan, how long the condition has been stable, and prognosis; ☐ List of medications and presence or absence of side effects (if any) with specific attention to any chemotherapy, steroids, or hormone agents and dates used; ☐ Treatment records including clinic notes or a summary letter describing initial staging, disease	DEFERInitial Special Issuance – Requires FAA DecisionFollow up Special Issuance will be per the airman’s authorization letter
	course, locations of metastatic disease, and stability; ☐ Operative notes and discharge summary, if applicable; ☐ Pathology report(s), if applicable; and ☐ Results of MRI/CT or PET scan reports. (In some cases, the actual CDs will be required in DICOM format for FAA review).

Notes: If the airman is currently on radiation or chemotherapy, the treatment course should be completed before medical certification can be considered.

CACI – Prostate Cancer Worksheet

(Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE CERTIFICATION
• CRITERIA
• The treating physician’s current, detailed

Clinical Progress Note verifies:

(Chemotherapy/radiation, etc.) and no further treatment is recommended at this time; and

o Has made a full recovery; and o Has been released by the surgeon [ ] Yes Current PSA (within the last 6 months) [ ] 20 or less if no prostatectomy [ ] 0.2 or less after prostatectomy

Symptoms [ ] None

Current treatment

Notes: If it has been 5 or more years since the airman has had any treatment for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required. Note this in Block 60. (See disposition table.)

[ ] None or active surveillance/watchful waiting or Brachytherapy

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified prostate cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified prostate cancer.

[ ] NOT CACI qualified prostate cancer. I have deferred. (Submit supporting documents.)

• RENAL CANCER
• All Classes
• (Updated 09/30/2015)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Non metastatic with treatment completed 5 or more years ago	If no recurrence or ongoing treatment:	ISSUE Summarize this history in Block 60.
B. Non metastatic with treatment completed less than 5 years ago	See CACI worksheet.	Follow the CACI-Renal Cancer Worksheet Note in Block 60
C. Metastatic disease Current OR any time in the pastORRecurrence of disease	Submit the following to the FAA for review: ☐ Current, detailed Clinical Progress Note generated from a clinic visit with the treating oncologist no more than 90 days before the AME exam. It should describe the treatment plan, how long the condition has been stable, prognosis, and if any upcoming treatment change is planned or expected; ☐ List of medications and presence or absence of side effects with specific mention of chemotherapy and dates used; ☐ Treatment records including clinic notes or a summary letter describing initial staging, disease course, locations of metastatic disease, and stability; ☐ Operative notes and discharge, if applicable; ☐ Pathology report(s), if applicable; ☐ Results of MRI/CT or PET scan reports. (In some cases, the actual CDs will be required in DICOM format for FAA review.); and ☐ Copies of most recent lab results performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow-up Special Issuance – Will be per the airman’s authorization letter

CACI – Renal Cancer Worksheet

(Updated 04/13/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified renal cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified renal cancer.

[ ] NOT CACI qualified renal cancer. I have deferred. (Submit supporting documents.)

TESTICULAR CANCER

All Classes (Updated 08/26/2015)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Non metastatic and treatment completed 5 or more years ago	No recurrence or ongoing treatment:	ISSUE Summarize this history in Block 60.
B. Non metastatic and treatment completed less than 5 years ago	See CACI worksheet.	Follow the CACI -Testicular Cancer WorksheetNote in Block 60.
C. Metastatic disease current OR any time in the pastRecurrence of disease	Submit the following to the FAA for review: ☐ Current, detailed Clinical Progress Note, generated from a clinic visit with the treating oncologist no more than 90 days before the AME exam, describing treatment plan and prognosis; ☐ List of medications with attention to any chemotherapy agents and dates used; ☐ Treatment records including clinic notes or summary letter describing disease course and initial staging; ☐ Operative notes and discharge summary (if applicable); ☐ Pathology report(s) (if applicable); ☐ MRI/CT or PET scan reports (in some cases, the actual CDs will be required in DICOM format for FAA review); and ☐ Serum tumor markers results (if applicable).	DEFERSubmit the information to the FAA for a possible Special Issuance.

Notes: If the airman is currently on radiation or chemotherapy, the treatment course must be completed before medical certification can be considered. Watchful waiting is allowed. See CACI – Testicular Cancer Worksheet.

CACI – Testicular Cancer Worksheet

(Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE CERTIFICATION
• CRITERIA
• The treating physician’s current, detailed Clinical

Progress Note verifies:

(chemotherapy/radiation, etc.) and no new treatment is recommended at this time; and

• [ ] Yes
• Symptoms [ ] None
• Current treatment

Notes: If it has been 5 or more years since the airman has had any treatment for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required. Note this in Block 60. (See disposition table.)

If the airman is currently on chemo or radiation treatment, defer the exam. (See disposition table).

[ ] None, surveillance or watchful waiting

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified testicular cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified testicular cancer.

[ ] NOT CACI qualified testicular cancer. I have deferred. (Submit supporting documents.)

• OTHER G-U CANCERS/NEOPLASTIC DISORDERS
• All Classes
• Updated 09/30/2015

NEPHRITIS

All Classes

• POLYCYSTIC KIDNEY DISEASE
• All Classes
• (Updated 07/29/2020)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Autosomal Dominant (AD-PKD)	Submit the following to the FAA for review: ☐ A current, detailed Clinical Progress Note generated from a clinic visit with the treating Nephrologist no more than 90 days before the AME exam, detailing: o History, diagnosis, physical exam; o Treatment plan and prognosis; and o If airman has hypertension, the physician should comment if it is controlled. ☐ Medication list and side effects (if any); ☐ Lab (recent) to include at a minimum: Serum creatinine; o eGFR; and o Spot urine protein/creatinine ratio ☐ Imaging to include: o Brain MRA (preferred) or CTA (if MRI contraindications) for aneurysm; and o Current transthoracic echocardiogram.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.
B. Autosomal recessive (AR-PKD)	Submit the following to the FAA for review: ☐ A current, detailed Clinical Progress Note generated from a clinic visit with the treating Nephrologist no more than 90 days before the AME exam, detailing: o History, diagnosis, physical exam; o Treatment plan and prognosis; and o If airman has hypertension, the physician should comment if it is controlled. ☐ Medication list and side effects if any;	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.
	☐ Lab (recent) to include at a minimum: o Serum creatinine; o eGFR; and o spot urine protein/creatinine ratio ☐ Gastroenterologist current evaluation detailing: o History, diagnosis, physical exam; o Current status; o Treatment plan and prognosis; o Abdominal ultrasound; and ☐ Liver function testing plus any additional testing deemed clinically indicated.

• URINARY SYSTEMS
• All Classes
• (Updated 09/30/2015)