Referral criteria from primary care - bladder outflow obstruction

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:

1. NICE (May 2000). Referral Practice A guide to appropriate referral from general to specialist services.