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ICCS S2-7
(P)
REFERRAL PATTERN FOR WETTING CHILDREN TO A PAEDIATRIC UROLOGY
CENTER: WHO SHOULD SEE WHAT?
Alex SCARLETT, Kimberley CHIN-GOH, Mohamed CHOUDRI, Nicholas MADDEN, Nisha RAHMAN, Marie-Klaire FARRUGIA
and Diane DE CALUWE
Chelsea and Westminster Hospital Foundation Trust, Department of Paediatric Surgery and Urology, London, UNITED
KINGDOM
PURPOSE
Management of day and or night time incontinence forms a significant proportion of a urology service. Clinics can be
time consuming and patients are often seen for prolonged periods. This can cause a burden upon available services. Our
aim was to review the referral pattern within our network and develop a more efficient referral pathway.
MATERIAL AND METHODS
A retrospective review of all referrals to a paediatric urology clinic was performed over a 3year period. Referrals for
continence related issues were identified and stratified according to symptoms and management prior to referral. A
consensus was gained within our consultant cohort of suitable referrals. This was carried out in accordance with national
guidelines.
RESULTS
300 of 940 referrals between 2012-2014 were continence related. A third were considered to be ‘inappropriate’ referrals,
including primary nocturnal enuresis (PNE), wetting with associated behavioural or developmental issues, concurrent
bowel disease. Patients with PNE and daytime wetting (45%) could have been initially assessed by a continence nurse
specialist (CNS) to carry out relevant investigations (e.g. non-invasive urodynamics). 22% of referrals were considered
to be ‘appropriate’, including intractable PNE, continuous daytime wetting and wetting associated with congenital
anomalies and recurrent infections.
CONCLUSIONS
With further education and a network pathway, a third of referrals for continence issues could be managed locally before
involvement of the paediatric urologist. An experienced CNS within the department can streamline the service and frees
up the consultant to manage the complex cases. Implementation of the pathway can improve efficiency and reduce
departmental costs.