When should I consider referring a patient with overactive bladder to a specialist for further evaluation?

Consider referring a patient with overactive bladder to a specialist for further evaluation if:

• They have overactive bladder symptoms that have not responded to non-surgical management or pharmacological treatment and wish to discuss further treatment options, such as invasive procedures or botulinum toxin type A injection.
• There are symptoms suggestive of voiding dysfunction, recurrent urinary tract infections, or other complicating factors such as palpable bladder after voiding, bladder or urethral pain, clinically benign pelvic masses, associated faecal incontinence, suspected neurological disease, suspected urogenital fistulae, previous continence surgery, or previous pelvic cancer surgery or radiation therapy.
• There is a need for urodynamic investigation to determine if detrusor overactivity is causing the symptoms before considering invasive treatments.
• There are concerns about possible urinary tract cancer, such as haematuria or recurrent/persistent unexplained urinary tract infections, which require referral according to suspected cancer guidelines.

Referral should be considered after initial assessment and management in primary care, including lifestyle advice, bladder training, and medication trials, have been undertaken without satisfactory symptom control.

Women on long-term medication for overactive bladder should be reviewed regularly in primary care, but referral is indicated when symptoms persist despite treatment or when invasive treatment options are being considered.

Specialist referral often involves a multidisciplinary team (MDT) review to discuss invasive treatment options and risks, including botulinum toxin type A injections and the potential need for clean intermittent catheterisation.

These recommendations are based on NICE guideline NG123 on urinary incontinence and pelvic organ prolapse in women and the NG12 guideline on suspected cancer for relevant symptoms.

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