BAUS 2015

Introduction: Recurrent urinary tract infections (UTI) in female patients are a common referral to urology, yet much of the investigation and advice follow a standard protocol. Our intention was to standardise and streamline treatment. We established a nurse-led UTI clinic in 2014, which sees increasing patient numbers every year. The clinic is overseen by a consultant, specialising in Female, Neurological and Urodynamic Urology. This re-audit assesses the investigations requested and the overall outcomes of the UTI clinic.
Patients and methods: We re-audited all patients seen in the clinic from 2017 to 2019 (n=836), looking at per-protocol investigations requested, particularly flexible cystoscopy (n=256) and ultrasonography (n=813). We also audited the rate of referral to consultant clinics and discharge rate at 6 months.
Results: The median wait from referral time was 19 weeks. Ultrasound scans were positive for any pathology in 15% of patients, and cystoscopy positive in 12.5%. At 6 months, around 75% of patients were discharged, with only 11% of patients requiring referral to consultant urology clinics. 2 cancers were picked up, but much quicker (both less than 3 months) than if they had waited for general consultant clinics at point of referral. Unfortunately, both patients had advanced cancers at diagnosis.
Conclusions: A well-run, protocol driven nurse-led UTI clinic provides consistent care to patients and reduces pressure on consultant clinics. It also allows for additional investigations based on history taking to ensure appropriate use of cystoscopy and imaging. Regular re-audit allows evidence-based protocol adjustments to continually improve use of resources.