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Lower urinary tract symptoms (female)

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • Refer to HealthPathways
  • Medical management
    • Bladder chart/diary – time and volume chart
    • MSU
    • Physiotherapy and/or continence nurse management e.g. pelvic floor muscle exercises and bladder training
    • Consider USS urinary tract and post-void residual measurement
    • Consider anticholinergics: if low residuals on bladder scan, no suspicion of a sinister cause, not hypersensitive to the drug, and no history of acute angle glaucoma

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Abnormal USS suggestive of urinary tract tumour or suspicion of malignancy
  • Elevated post-void residuals (> 300mls) and hydronephrosis on USS and/or altered renal function
  • Severe irritative symptoms
  • Haematuria and/or sterile pyuria
  • Known or suspected neurogenic bladder and/or neurological symptoms
  • Suspected urogenital fistulae
Category 2
(appointment within 90 calendar days)
  • USS suggestive of bladder outlet obstruction
  • Bladder stones
  • Elevated post-void residuals > 100ml
  • Nocturnal incontinence
  • Suspected or proven urethral stricture and/or urethral diverticulum
  • Acute change in long-term catheter
  • Persistent or progressive symptoms despite maximal medical management
  • Moderate to severe pelvic organ prolapse
  • Previous incontinence/prolapse/pelvic surgery and/or pelvic radiation /malignancy
Category 3
(appointment within 365 calendar days)
  • Recurrent UTI (> 3 per year)
  • Persisting bladder or urethral or perineal pain
  • Socially limiting (severe)
  • Ineffective physiotherapy/continence nurse management
  • Ineffective anti-cholinergic and beta3 adrenergic agonist therapy

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service\

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Lower urinary tract symptoms (female) referrals (Referral will be returned without this)

  • Full perineal examination
  • MSU M/C/S results
  • USS urinary tract results
  • Smoking history (even if negative)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Lower urinary tract symptoms (female) referrals

  • History of previous incontinence/prolapse/pelvic surgery and/or pelvic radiation/malignancy
  • Bladder diary – time and volume chart
  • ELFT results

Emergency

 

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

Acute/severe renal or ureteric colic
Acute renal or ureteric colic with obstruction and/or infection
Acute urinary retention
Urinary tract and genital trauma
Urinary tract sepsis or severe infection
Severe urinary tract bleeding
Autonomic dysreflexia
Foreign bodies
Priapism
Acute scrotal pain/ torsion of the testes
Severe genital infection e.g. Fournier's gangrene/epididymo-orchitis
Paraphimosis – unable to reduce

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 16 February 2024