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Incontinence - urinary, in women - Management
Who should I refer for further investigations?
- Refer urgently (within 2 weeks) to a urologist if the woman has:
- Macroscopic (visible) haematuria without urinary tract infection.
- Unexplained microscopic (non-visible) haematuria and is 50 years of age or older.
- Recurrent or persistent urinary tract infection with haematuria and is 40 years of age or older.
- A suspected malignant mass arising from the urinary tract or pelvis.
- Refer to an appropriate specialist (urologist or urogynaecologist), using clinical judgement to determine urgency if there is:
- A bladder that is palpable on abdominal or bimanual examination after voiding and/or chronic urinary retention (overflow incontinence)/voiding difficulties. The post-void residual volume will need to be measured.
- Symptomatic pelvic organ prolapse that is visible at or below the introitus.
- Persistent bladder or urethral pain (refer urgently if cancer is suspected).
- A pelvic mass that is clinically benign, such as uterine enlargement.
- Associated faecal incontinence.
- Suspected or known neurological disease.
- Suspected urogenital fistula.
- A history of previous prolapse surgery, incontinence surgery, pelvic cancer surgery, or previous radiation therapy.
- Recurrent urinary tract infection.
- Microscopic (non-visible) haematuria in a woman who is younger than 50 years of age.
- Refer to a renal physician if there is also proteinuria or raised serum creatinine levels.
- Refer non-urgently to a urologist if there is no proteinuria and serum creatinine level is normal.
- Complex comorbid medical disease and multiple medications.
Basis for recommendation
Urgent referral
Referral (using clinical judgement to determine urgency)
Measuring the residual volume
- NICE recommends measuring the residual volume in women with suspected voiding dysfunction or with recurrent urinary tract infection. Most of these women will be referred to a urologist for further investigations. NICE recommends referral for ultrasonography of the bladder to measure the volume of residual urine, as this is more acceptable and has less adverse effects than catheterization [National Collaborating Centre for Women's and Children's Health, 2006].
- Three studies compared portable ultrasonography with catheterization and concluded that, compared with catheterization (which is the gold standard but is less acceptable and has more adverse effects), ultrasonography was within clinically acceptable limits.
- The sensitivity of bimanual examination is poor; only one in seven women with a post-void volume greater than 50 mL is detected by bimanual examination [Nygaard, 1996].
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