Lower urinary tract symptoms (male) Referral Access Criteria
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
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
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- Chronic urinary retention with deteriorating renal function or hydronephrosis
To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)
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| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Lower urinary tract symptoms
- Urge or stress or mixed or continuous urinary incontinence (where medical therapies have been tried and failed)
- Men with complex lower urinary tract symptoms and any of the following:
- bladder stones
- elevated post-void residuals > 150mL
- urinary retention
- hydronephrosis
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| Mandatory information |
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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.
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| History |
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Relevant history, onset, duration and severity of symptoms
- Details of previous treatment and outcome
- Current medication list
- Any known allergies
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| Examination |
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| Investigations |
- MSU (or CSU) MCS
- U&E
- PSA (within 2 years)
- Urinary tract ultrasound (US) (preferred) or CT intravenous pyelography (IVP)
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
- Any previous PSA results
- STI screening (Chlamydia and gonorrhoea)
- International Prostate Symptom Score (I-PSS)
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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- Significant abnormality on imaging (e.g. hydronephrosis, bladder mass)
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Category 2
Appointment within 90 days
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Urinary symptoms without any significant abnormality on imaging
- Debilitating symptoms such as incontinence
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Category 3
Appointment within 365 days
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No defined category 3 criteria
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| Useful information |
- Please note that the patient may be triaged directly to a flexible cystoscopy from this referral.
- If the patient has predominantly voiding symptoms (e.g. poor flow, incomplete emptying) consider trial of medical therapy (e.g. alpha blocker such as prazosin 0.5mg-2mg twice a day, tamsulosin 400mcg daily or silodosin 4-8mg daily) before specialist referral
- If patient has predominantly storage symptoms (e.g. urgency, frequency, nocturia) consider trial of medical therapy (e.g. beta3 adrenergic agonist such as Betmiga Mirabegron at 25-50mg daily; anti-cholinergic such as oxybutynin 5mg three times a day or oxybutynin transdermal patch) before specialist referral.
- Suggest patient assesses their fluid intake and trials conservative measures before specialist referral (e.g. caffeine/alcohol reduction, pelvic floor exercises).
- See: International Prostate Symptom Score
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Last reviewed: 29-04-2025