Signs and Symptoms

• Pyrexia
• Urgency/Bypassing and bleeding (this can also be a sign of bladder stones)
• Loin pain
• General malaise
• Confusion
• Offensive smelling and cloudy urine. NB changes in urine should not be considered in isolation or to be the driver for prescribing antibiotics as all indwelling catheters will have a biofilm of bacteria within hours of insertion resulting in asymptomatic bacteraemia

History and Examination

• General history
• Assess appearance of urine
• Examine urethral meatus or supra-pubic site for evidence of inflammation, trauma or poor hygiene (this information should be available in community nurse records if catheter has been recently changed)
• If loin pain experienced, consider renal stones and examine urine for grit

Differential Diagnosis

• Systemic infection arising elsewhere (e.g. chest)
• Renal colic
• CAUTI associated with bladder stones

New frank haematuria – see guideline

• Catheter specimen of urine (CSU)
• Dipstick urinalysis is not required (NICE QS90)

Please see formulary guidance:

Chapter 5 - Urinary Tract Infections

Continence

Referral Criteria

Refer to urology if bladder stones or renal calculi suspected

Referral Instructions

e-Referral Service Selection

• Specialty: Urology
• Clinic Type: Urinary Calculus
• Service: DRSS South Devon & Torbay – Urology Devon ICB – 15N

Referral Form

DRSS referral form

Pathway Group

This guideline has been signed off on behalf of the NHS Devon.

Publication Date: April 2019