Lower urinary tract symptoms (male) Referral Access Criteria

Referrers should use this page when referring patients to public adult urology outpatient services for lower urinary tract symptoms (male).

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Acute, painful urinary retention

Immediate referral
Immediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
Chronic urinary retention with deteriorating renal function or hydronephrosis To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Severe lower urinary tract symptoms (i.e. 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 (i.e. IPSS 0-19) that have not responded to medical management (eg.5α-reductase inhibitors, α 1a-adrenoreceptor antagonist)

Clinical indications for outpatient referral

If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

Severe lower urinary tract symptoms (i.e. 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 (i.e. IPSS 0-19) that have not responded to medical management (eg.5α-reductase inhibitors, α 1a-adrenoreceptor antagonist)

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Details of previous treatment and outcome
Examination	Nil
Investigations	MSU or CSU M/C/S U&Es PSA Urinary tract USS including post-void residual or CT IVP

Indicative clinical urgency 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

Indicative clinical urgency 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

Category 3

Appointment within 365 days

Exclusions
Nil

Useful information
Nil

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Last reviewed: 05-01-2024

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