Outcome audit of nurse‐led lower urinary tract symptoms clinic: lessons and challenges for practice

Abstract

AbstractThe objective of this article was to review the outcome of assessments performed at a recently established nurse‐led one‐stop male lower urinary tract symptom (LUTS) assessment clinic. Retrospective audit was performed on 107 patients assessed between December 2006 and August 2007. Information obtained included demographics, symptoms, International Prostatic Symptom Score (IPSS), prostate‐specific antigen (PSA), electrolyte profile, mid‐stream sample of urine (MSSU), ultrasound scan of renal tracts, uroflowmetry (urinary flow studies), management plan and clinical outcome. The mean age of the patient was 65·8 years, and patients waited 15·7 weeks (previously up to 2 years) for consultation. Symptomatically, 51% had moderate (IPSS score 8–19) and 38% had marked symptoms (score 20–35), and 43·5% reported sexual dysfunction. The mean PSA, prostatic volume and postvoid residual urine volume were 4·9 ng/mL, 50·4 cc and 101·9 mL, respectively. The average maximum urinary flow was 14·9 mL/s, and only 1% of all MSSU obtained revealed urinary tract infection. The final clinical outcomes identified nine prostate cancers, three renal cancers, three bladder calculi, two urethral strictures, two atonic bladders, one new‐onset diabetes and one pelvi‐ureteric junction obstruction. From a treatment perspective, 70·1% patients had alpha‐blockers, 42·9% had a 5‐alpha reductase inhibitor, 15% had anticholinergics, 1% had transurethral incision of prostate, 2% had optical urethrotomy, 3% had cystolitholapaxy, 3% had radical nephrectomy and 8% had transurethral resection of prostate. This clinic had significantly reduced the waiting time for first assessment in people with LUTS. Additionally, it has highlighted areas for further refinement and revision and firmly establishes the need for ongoing reaudit. We tentatively suggest the inclusion of ultrasound renal tracts as part of LUTS assessment.