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Lower urinary tract symptoms (male)

Lower urinary tract symptoms – Adult (male)

Emergency and immediate referrals

Referral to Emergency Department

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

  • Acute, painful urinary retention

Immediately contact the on-call registrar or service to arrange an immediate urology assessment (seen within 7 days) for:

  • Chronic urinary retention with deteriorating renal function or hydronephrosis

To contact the relevant service, please see HealthPathways: Acute Urology Assessment

Presenting issues
  • Severe lower urinary tract symptoms (ie IPSS ≥20)
  • Urge, stress or mixed or continued urinary incontinence (where medical therapies have been tried and failed)
  • Men with complicated lower urinary tract symptoms who may have:
    • bladder stones
    • elevated post-void residuals > 150mL
    • hydronephrosis
    • mild to moderate symptoms (ie IPSS 0-19) that have not responded to medical management (e.g. 5α-reductase inhibitors, α 1a-adrenoreceptor antagonist)
Mandatory referral information (referral will be returned if this information is not included)

History

  • Details of previous treatment and outcome

Investigations

  • MSU or CSU M/C/S
  • U&Es
  • PSA
  • Urinary tract USS including post-void residual or CT IVP

If unable to attach reports, please include relevant information/findings in the body of the referral   

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • PSA history
  • Bladder diary
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Abnormal USS suggestive of urinary tract tumour
  • Elevated post-void residuals AND hydronephrosis on USS and/or altered renal function
  • Bladder stones
  • Severe irritative symptoms (impairing quality of life) and any of the following:
    • haematuria
    • suspicion of malignancy
  • Acute urinary retention post IDC insertion
Category 2
Appointment within 90 days
  • USS suggestive of bladder outlet obstruction
  • Recurrent UTI (> 1 per year)
  • Elevated post-void residuals > 200ml
  • Suspected or proven urethral stricture
  • Acute change in patient with long-term catheter
  • Persistent or progressive symptoms despite maximal medical management
  • Incontinence
Category 3
Appointment within 365 days
  • No defined category 3 criteria
Excluded urology services

Referral to public adult urology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Lower urinary tract symptoms

 Excluded condition for the following:
Last reviewed: 05-01-2024
wa.gov.au