Category
Threshold Criteria
Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra, and, in men, the prostate.
LUTS are a common problem. The pathway enables that full investigations required are carried out in primary care to ensure that those who need hospital evaluation on are seen quickly, investigated thoroughly and then, wherever possible, passed back to Primary Care, where the majority of LUTS can be managed safely.
Eligibility
| LLR ICB will fund secondary care referral for Lower Urinary Tract Symptoms if the following assessment has been made in primary care Patients need to be referred via the 2 WW pathway if they have – Raised age related PSA – A hard irregular prostate – Significant haematuria Patients with one or more symptoms: – Frequency – Nocturia – Difficulty in passing urine – Dribbling Initial Consultation History – Medical, emotional, physical, psychological, sexual, and social issues – Review of all current medication (including over the counter and herbal medication) Exclusion of alternative morbidities – U&E/ eGFR if you suspect renal impairment – Fasting blood sugar – Full blood count – Dip stick urine test – IPSS score (patient must complete the “Quality of Life “ section) – Frequency volume chare to differentiate the type of LUTS – PSA test Discussion of PSA test if appropriate and full consultation carried out with patient before undertaking. Postpone PSA test for at least one month after treatment of proven UTI. Two Week Review – Review the investigations – Review frequency volume chart Storage Predominant LUTS – Symptoms – Frequency – Urgency – Consider – Supervised bladder training – Anticholinergic drugs – Containment products e.g. pads or collecting devices – External collecting devices (sheath appliances, pubic pressure urinals) – Indwelling catheterisation – Referral to the community continence team Voiding – predominant LUTS Symptoms – Hesitancy – Poor Flow Consider – Alpha blocker – 5-alpha reductase inhibitor +/- alpha blocker (review in 3-6 months) if – Prostate >30g (enlarged) OR – PSA >1.4mg/ml For persistent storage symptoms Consider – Alpha blocker + anticholinergic – Intermittent bladder catheterisation – Where a patient is catheterised urine output must be monitored – If urine output is > or equal to 200 ml/hr patient will need to be admitted for IV fluid support For patient with other underlying causes identified i.e. obstructive uropathy Refer to urology Review in 4-6 week – Improvement in symptoms – Continue treatment – No improvement of symptoms- Discuss possible surgical options and the risks associated with surgery Refer to Urology if – Patient agrees and expresses a preference for surgery – Bothersome LUTS that does not respond to conservative management or drugs – Retention continues – LUTS are complicated by recurrent or persistent UTI |
| ARP 67 Review Date: 2026 |
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