• Kevin G Keane, InderMohammud ShakeelMSDepartment of Urology, Tallaght University Hospital, Dublin, Ireland., Caroline McIntyre, Shawgi Omer, Elizabeth McEvoy, Lisa G Smyth, Rowan G Casey, Arun Z Thomas, Rustom P Manecksha, and Robert J Flynn.
• Department of Urology, Tallaght University Hospital, Dublin, Ireland. kevin.keane@ucdconnect.ie.
• Ir J Med Sci. 2021 Aug 1; 190 (3): 1123-1128.

BackgroundWith among the lowest urologist per population ratios in Europe, the demand for urology specialist review in Ireland far exceeds supply. Lower urinary tract symptoms (LUTS) account for a significant number of referrals. The traditional paradigm of every patient being reviewed in a consultant-led clinic is unsustainable. New models of care with nurse-led clinics represent an opportunity to optimise limited resources.MethodsExisting long-waiting male LUTS referrals were triaged to a specialist nurse-led LUTS clinic. After urology CNS assessment, charts were reviewed by a consultant urologist and a plan formulated. Relevant data were prospectively collected and analysed.ResultsFifty-eight new male patients with LUTS were seen over a 6-month period with an average waiting time of 15.8 months. Patients were assessed with uroflowmetry, IPSS and DRE. Mean age was 64, IPSS 14.5, Qmax 18.3 ml/s and PVR 89 ml. Thirty patients (52%) were discharged directly with lifestyle modification and medical therapy. Twenty-eight patients (48%) required one or more further investigations and subsequent review; 11 had flexible cystoscopy, 4 had urodynamics, 5 had prostate MRI, and 2 patients were listed for surgery (TURP and circumcision). The remaining 10 patients were for review post trial of lifestyle modifications and/or medical treatment. After review/investigations, 4 more patients were discharged. A total of 32 patients (55%) were discharged or listed for surgery after initial assessment. This total increased to 62% after a second review/investigations.ConclusionIntroduction of a CNS-led LUTS clinic has significantly reduced the number of patients requiring follow-up in general urology clinics, representing a quality improvement in service provision.© 2020. Royal Academy of Medicine in Ireland.

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