Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- suspected cauda equina syndrome
- suspected spinal cord compression
- acute urinary retention
- urinary tract sepsis/systemic infection
- obstructive uropathy/renal failure due to bladder outlet obstruction
Please contact the urology registrar on call to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
National Continence Helpline
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Exclusions
- uncomplicated lower urinary tract infections without first line management treatment therapy
- sexually transmitted infections – refer to Adelaide Sexual Health Centre
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- suspected malignancy
- acute urinary retention post-trial-of-void (TOV)
- post-volume residuals (PVRs) greater than 300mls with:
- altered renal function and/or
- hydronephrosis
Category 2 (appointment clinically indicated within 90 days)
- bladder stones
- known or suspected neurogenic bladder
- nocturnal enuresis
- previous incontinence/pelvic surgery and/or pelvic radiation/malignancy
- recurrent urinary tract infections (UTIs)
- refractory symptoms despite maximal medical management
- repeated episodes of urinary retention
- suspected/confirmed urogenital fistula
- urethral stricture/meatal stenosis
Category 3 (appointment clinically indicated within 365 days)
- incontinence
- persisting bladder/urethral/perineal pain
For more on outpatient referrals, see the general referral information page.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- past medical/surgical/psychosocial history
- current medications, allergies
- history of presenting complaint including:
- onset
- duration
- incontinence and/or
- pelvic surgery and/or
- pelvic radiation/malignancy
- trial of medications, specifically alpha blockers, 5 alpha reductase inhibitors, anticholinergic agent, beta-3 adrenergic antagonists, phosphodiesterase type 5 inhibitor
- physical examination findings
- abdominal examination
- digital rectal examination (DRE)
- bladder diary – fluid intake/output chart
- kidneys, ureters and bladder (KUB) ultrasound (US) with post void residual volume
- relevant diagnostic/imaging reports including location of company and accession number
Pathology
- complete blood examination (CBE)
- electrolytes, urea and creatinine (EUC)
- liver function test (LFT)
- estimated glomerular filtration rate (eGFR)
- prostate-specific antigen (PSA)
- mid-stream urine (MSU) M/C/S
- urine cytology
- sexually active people please complete a sexually transmitted infection (STI) screen, including chlamydia and gonorrhoea which requires:
- endocervical/penile swab for culture and
- endocervical/penile polymerase chain reaction (PCR) swab or urine sample
Clinical management advice
Physiotherapy and/or continence nurse management should be considered as part of initial management for urinary incontinence e.g. pelvic floor muscle exercises and bladder training. All patients require kidney, ureters, and bladder ultrasound including post void residual volume.
Consider first line medication therapy if low residuals on bladder scan, no suspicion of a sinister cause, not hypersensitive to the drug, and no history of acute angle glaucoma.
Clinical resources
- Australian Medical Association - New Stolen Generation resources for GPs
- Cancer Council Australia – Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer
- Continence Foundation of Australia - Academic resources
- National Institute for Health and Care Excellence (NICE) - Lower UrinaryTract Symptoms in Men: Management
- Prostate Cancer Foundation of Australia – Clinical Practice Guidelines on PSA Testing
- Royal Australian College of General Practitioners (RACGP) - Overactive Bladder Syndrome Management and Treatment Options
- Urogynaecological Society of Australasia (UGSA) – Overactive Bladder
- UGSA – Stress Urinary Incontinence