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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