Last reviewed dd mmm yyyy. Last edited dd mmm yyyy
Most men with evidence of urinary tract ‘outflow’ symptoms can be managed in primary care. They should, however, be referred to a specialist service if:
****they develop acute urinary retention
****they have evidence of acute renal failure
*** they have visible haematuria
*** there is the suspicion of prostate cancer based on the finding of a nodular or firm prostate, and/or a raised PSA
*** they have persistent dysuria resistant to treatment with antibiotics
*** they develop chronic urinary retention with overflow incontinence
** they have a recurrent urinary tract infection
** they develop microscopic haematuria
* they are unresponsive to, or intolerant of, drug therapies
+ the diagnosis is, or becomes, uncertain, or the symptoms (reduced flow, nocturia, night-time incontinence etc) have failed to respond to treatment in primary care and are severe enough to affect quality of life. This is best assessed by the patient using a symptom scoring system such as WHO’s International Prostate Symptom Score (IPSS)
+ they have evidence of chronic renal failure or renal damage
Key to referral times:
**** immediate referral (a)
*** urgent referral (b)
** soon (b)
* routine (b)
+ times will be discretionary and depend on clinical circumstances
(a) within a day
(b) Health authorities, trusts and primary care groups should work to local definitions of maximum waiting times in each of these categories. The multidisciplinary groups considered that a maximum waiting time of 2 weeks is appropriate for the urgent category
Reference:
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