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.

  • acute urinary retention
  • hydronephrosis with chronic urinary retention and, impaired renal function
  • severe urinary tract infection/systemic infection
  • suspected cauda equina syndrome
  • suspected spinal cord compression

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

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • significant pelvic organ prolapse contributing to voiding symptoms, in particular procidentia - refer to gynaecology/urogynaecology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy
  • obstructive uropathy requiring catheterisation

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

Category 3 (appointment clinically indicated within 365 days)

  • incontinence
  • persisting bladder/perineal pain

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.

  • relevant past medical/surgical history
  • current medications specifically any anticholinergics or beta-3 antagonists
  • allergies
  • relevant past medical/surgical history
  • history of presenting complaint including:
    • onset
    • duration
    • incontinence and/or
    • prolapse and/or
    • pelvic surgery and/or
    • pelvic radiation/malignancy
  • bladder diary - time and volume chart
  • physical examination findings:
    • abdominal and pelvic examination
    • latest pap smear results
  • kidneys, ureters and bladder (KUB) ultrasound (US) with post void residual volume
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • electrolytes, urea & creatinine (EUC)
  • liver function test (LFT)
  • estimated glomerular filtration rate (eGFR)
  • coagulation studies (Coags)
  • mid-stream urine (MSU) M/C/S
  • urine cytology
  • sexually active people 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. This would include vaginal oestrogen in post-menopausal women, anticholinergics or beta-3 agonists.

Refer to gynaecology where significant pelvic organ prolapse contributing to voiding symptoms, in particular organ/mucosal involvement. Symptoms may include:

  • a feeling of a lump/bulge in the vagina or coming out of the vagina
  • urinary symptoms such as:
    • slow urinary stream
    • incomplete bladder emptying sensation
    • frequency
    • urgency
    • urinary tract infection
    • stress incontinence
  • bowel symptoms such as:
    • difficulty with bowel motions
    • incomplete defecation sensation
    • needing to press on the vaginal wall to evacuate bowel (splinting)

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.