Referral criteria from primary care - lower urinary tract dysfunction in neurological disease

Refer people for urgent investigation if they have any of the following 'red flag' signs and symptoms:

• haematuria
• recurrent urinary tract infections (for example, three or more infections in the last 6 months)
• loin pain
• recurrent catheter blockages (for example, catheters blocking within 6 weeks of being changed)
• hydronephrosis or kidney stones on imaging
• biochemical evidence of renal deterioration

Notes:

• be aware that unexplained changes in neurological symptoms (for example, confusion or worsening spasticity) can be caused by urinary tract disease, and consider further urinary tract investigation and treatment if this is suspected
• refer people with changes in urinary function that may be due to new or progressing neurological disease needing specialist investigation (for example, syringomyelia, hydrocephalus, multiple system atrophy or cauda equina syndrome)
• bladder cancer
  • there may be an increased risk of bladder cancer in people with neurogenic lower urinary tract dysfunction, in particular those with a long history of neurogenic lower urinary tract dysfunction and complicating factors, such as recurrent urinary tract infections
  • arrange urgent (within 2 weeks) investigation with urinary tract imaging and cystoscopy for people with:
    • visible haematuria or
    • increased frequency of urinary tract infections or
    • other unexplained lower urinary tract symptoms

Reference:

• 1) NICE (August 2012). Urinary incontinence in neurological disease - Management of lower urinary tract dysfunction in neurological disease