Most lower urinary tract symptoms in older men are benign and can be managed in primary care. A few features change that.
Visible haematuria needs urgent investigation for bladder or kidney cancer. A palpably hard or irregular prostate, or a raised PSA for age, needs referral. A large painless residual or rising creatinine suggests chronic retention and possible renal damage. New incontinence with back pain or leg symptoms raises the question of cauda equina compression.
Also check the drug list: anticholinergics, opioids and decongestants can precipitate retention.
- Visible haematuria: urgent referral
- Abnormal prostate on examination or raised PSA: refer
- Large residual or rising creatinine: consider chronic retention
- Review drugs that cause retention, including anticholinergics and decongestants
Why it matters
The serious causes are uncommon but easy to miss in a short consultation.
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