Continence

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Acute Prostatitis Catheter Acquired Urinary Tract Infection (CAUTI) Chronic Pelvic Pain Syndrome / Chronic Prostatitis Circumcision commissioning policy Continence Epididymal Cyst Erectile dysfunction Haematospermia Haematuria Male Lower Urinary Tract Symptoms Nocturia Paraphimosis Peyronies Disease Phimosis Prostatitis suspected Surgical procedures for the treatment of LUTS caused by BPH Suspected Renal and Ureteric Stones Urinary Tract Infection (UTI) in females Urinary Tract Infection (UTI) in males Vasectomy

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Scope

All patients in scope should be referred to the Community Continence Advisory Service for a programme of conservative management

Patients will be assessed in a community based clinic.
Adults over the age of 18 with involuntary urinary or faecal loss.
Young adults transferring from child to adult continence service will be referred at the age of 17.6 years to streamline their transition.
This service is provided to patients who are registered with GP practices within Plymouth, South Hams and West Devon.
Following initial GP assessment, most patients with incontinence will benefit from an assessment at the community continence clinic.
Patients will be holistically assessed and will be supported using a conservative based programme to improve management of their continence problems, the assessment may include a bladder scan, conservative lifestyle advice and support.
Housebound patients are encouraged to attend the clinic if they are able, accessed through personal or ambulance transport.

Please Note: Pre-Choice Triage is currently active for this specialty and referrals submitted without this information may be returned.

Key pre-referral criteria summary:

Physical examination is indicated prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy. If physical examination is not appropriate please include reason in referral.

Out of scope

Symptomatic Prolapse visible at or below the vaginal intriotus, pelvic masses or urogenital fistulae should be referred to secondary care urogynaecology
Enlarged Prostate, Recurrent UTI should be referred to urology
Haematuria should be referred in accordance with local guidelines
- Haematuria guideline
- 2WW Urology guideline
A small minority of patients may be deemed unsuitable for onward referral for an ambulatory community clinic e.g. patients at end of life, clinically unable, please refer to the community continence service where a domiciliary visit can be arranged.
Referrals can be made via livewell.localityhub@nhs.net for those who require routine support with urinary catheter services.
Recurrent UTI in children should be referred to the Derriford nurse led clinic

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History and Examination

Physical examination is indicated where appropriate prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy

Vaginal and abdominal examination (women)
PR examination (men)
Urine test to exclude other abnormalities, treat then reassess
Assessment of pelvic floor
Medication Review
Containment products can be purchased from chemists or supermarkets. Sanitary towels are not provided for urinary or faecal loss

Urine test to be carried out prior to referral in order to exclude UTI. If UTI present, treat then reassess prior to referral
Vaginal and abdominal examination prior to referral where appropriate (women)
PR examination to exclude prostate problems prior to referral (men)

Referral Criteria

Physical examination is indicated where appropriate prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy

Please include in referral: