Management pathway

 

Adapted from NICE guidelines

History:

  1. LUTs symptoms

  2. Severity

  3. Impact

Examination

  1. Focused examination

  2. DRE


Investigations:
 Urine dipstick
 Bloods ( if appropriate)
 PSA  ( see guidance )
Uncomplicated

Complicated:

  1. Suspected chronic retention

  2. 1+ UTI or persistent UTIs with or without haematuria

  3. Elevated serum creatinine (2o to LUTs

  4. Acute urinary retention

  5. H/O renal stones

  6. Suspected stress urinary incontinence

Mild/ not bothersome

Moderate/severe or bothersome

Consider frequency volume chart

Review if worsening

Voiding symptoms:

  1. Weak stream

  2. Intermittency

  3. Straining

  4. Hesitancy

  5. Incomplete bladder emptying

Storage symptoms:

  1. Daytime frequency

  2. Nocturia

  3. Urgency

  4. Urinary incontinence



Consider
anti-cholinergic
ReferralReferral_criteria.html
Small (<30g)
prostate or PSA < 1.4
Large (>30g)
prostate or PSA > 1.4
Alpha blocker 4-6 weeks
5ARI
3-6 mth
Consider combination therapy or alternative Rx
Improved ?
YES
NO
Review 6 monthly
NO
NO

Offer advice e.g. fluid intake

Provide information

Suspected urological cancerManagement_of_LUTs_files/NICE%20Urological%20referral%20guidelines.pdf