Lower urinary tract symptoms (female) Referral Access Criteria

• Acute, painful urinary retention

• Chronic urinary retention with deteriorating renal function or hydronephrosis

• Lower urinary tract symptoms
• Urge or stress or mixed or continuous urinary incontinence (where physiotherapy and medical therapies have been tried and failed)

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.

• Relevant history, onset, duration, and severity of symptoms
• Details of previous treatment and outcome
• For incontinence: information of continence nurse or physiotherapy-led pelvic floor training exercises (PFTE) and/or referral and outcome
• Current medication list
• Any known allergies  

• Nil

• MSU (or CSU) MCS
• U&E
• Urinary tract ultrasound (US) (preferred) or CT intravenous pyelography (IVP)       

• For females: Menopause status
  • If peri-/post-menopausal female, details of any hormone replacement therapy (HRT) use or topical therapy and response.

• Examination findings e.g. pelvic mass, evidence of pelvic organ prolapse, vaginal epithelial atrophy

• STI screening (Chlamydia and gonorrhoea)

Category 1

Appointment within 30 days

• Significant abnormality on imaging (e.g. hydronephrosis, bladder mass)

Category 2

Appointment within 90 days

• No defined category 2 criteria         

Category 3

Appointment within 365 days

• Urinary symptoms with or without incontinence
• Incontinence requiring surgical treatment          

• Nil

• Please note that the patient may be triaged directly to a flexible cystoscopy from this referral.
• Consider vaginal oestrogen for post-menopausal women prior to specialist referral.
• If patient has predominantly storage symptoms (e.g. urgency, frequency, nocturia) consider trial of medical therapy before specialist referral for example:
  • beta3 adrenergic agonist such as Betmiga Mirabegron at 25-50mg daily;
  • anti-cholinergic such as oxybutynin 5mg three times a day
    • prior to starting anti-cholingeric medications, bladder ultrasound is required to exclude high residual bladder volume (up to 100ml is acceptable)
  • oxybutynin transdermal patch
• Suggest patient assesses their fluid intake and trials conservative measures before specialist referral (e.g. caffeine/alcohol reduction, pelvic floor exercises, bladder re-training).
• If patient has incontinence, consider referral to pelvic floor physiotherapist/continence nurse management.
  • For referrals to a pelvic floor physiotherapist in the community, see Continence Physio WA (external site)
  • Please note that patients referred to outpatient services may undergo assessment of their incontinence (e.g. cystoscopy, urodynamics) and trials of medical therapy for overactive bladder, however limited public health services offer surgical treatment for female stress incontinence.
  • If a public health service does offer surgical treatment, waiting times for assessment and treatment can be long.
• See HealthPathways: Adult Urinary Incontinence Requests (external site)
• See RACGP Clinical Guide Silver Book: Urinary incontinence (external site)
• See Pelvic Floor First (external site)
• See Continence Foundation of Australia (external site)
• See Australasian Menopause Society: Vulvovaginal symptoms after menopause (external site)
• See Australian Family Physician: Genitourinary syndrome of menopause (external site)