Incontinence/bladder dysfunction (female) (Urology)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Acute/severe renal or ureteric colic
    • Acute renal or ureteric colic with obstruction and/or infection
    • Acute urinary retention
    • Urinary tract and genital trauma
    • Urinary tract sepsis or severe infection
    • Severe urinary tract bleeding
    • Autonomic dysreflexia
    • Foreign bodies
    • Priapism
    • Acute scrotal pain/ torsion of the testes
    • Severe genital infection e.g. Fournier's gangrene/epididymo-orchitis
    • Paraphimosis – unable to reduce
    • Refer to Healthpathways or local guidelines

    Medical management

    • Bladder chart/diary – time and volume chart
    • MSU
    • USS urinary tract and post-void residual
    • Physiotherapy and/or continence nurse management e.g. pelvic floor muscle exercises and bladder training
    • Consider anticholinergics if low residuals on bladder scan, no suspicion of a sinister cause, not hypersensitive to the drug, and no history of acute angle glaucoma
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Suspected malignant mass
  • Bladder outlet obstruction
  • Haematuria or sterile pyuria
  • Elevated post-void residuals (> 300mls) and hydronephrosis on USS and/or altered renal function
  • Known or suspected neurogenic bladder
  • Suspected urogenital fistulae
Category 2
(appointment within 90 calendar days)
  • Incontinence requiring multiple (> 2) pad changes per day
  • Nocturnal incontinence
  • Post-void residual > 100ml
  • Associated faecal incontinence
  • Moderate to severe pelvic organ prolapse
Category 3
(appointment within 365 calendar days)
  • Incontinence requiring 1-2 pad changes per day and any of the following:
    • recurrent (> 3 per year) or persistent UTI
    • persisting bladder or urethral or perineal pain
    • socially limiting (severe)
    • Ineffective physiotherapy/continence nurse management
    • Ineffective anti-cholinergic and beta3 adrenergic agonist therapy

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • MSU M/C/S results
  • USS urinary tract results
  • ELFT results

3. Additional referral information Useful for processing the referral

  • Documented episodes of incontinence – bladder chart/diary, time and volume chart

4. Request

  • Patient's 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • 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.

Last updated: 18 April 2019

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