× NICE uses cookies to make the site better.  Learn more
A-Z
Topics
Latest

Urinary incontinence in neurological disease

About

What is covered

This interactive flowchart covers managing lower urinary tract dysfunction resulting from neurological disease and injury. The recommendations on assessment apply to people who have a neurological condition.

Updates

Updates to this interactive flowchart

10 June 2015 Urinary tract infections in adults (NICE quality standard 90) added.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on managing lower urinary tract dysfunction resulting from neurological disease and injury in an interactive flowchart

What is covered

This interactive flowchart covers managing lower urinary tract dysfunction resulting from neurological disease and injury. The recommendations on assessment apply to people who have a neurological condition.

Updates

Updates to this interactive flowchart

10 June 2015 Urinary tract infections in adults (NICE quality standard 90) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Urinary tract infections in adults (2015) NICE quality standard 90

Quality standards

Quality statements

Diagnosing urinary tract infections in adults aged 65 years and over

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

Quality statement

Adults aged 65 years and over have a full clinical assessment before a diagnosis of urinary tract infection is made.

Rationale

The accuracy of dipstick testing in adults aged 65 years and over can vary. It is therefore important that factors other than the results of dipstick testing are taken into consideration when diagnosing urinary tract infections in older people to ensure appropriate management and avoid unnecessary use of antibiotics.

Quality measures

Structure
Evidence of local arrangements to ensure a full clinical assessment is undertaken before a diagnosis of urinary tract infection is made in adults aged 65 years and over.
Data source: Local data collection.
Process
Proportion of adults aged 65 years and over who received a full clinical assessment before being diagnosed with a urinary tract infection.
Numerator – the number in the denominator diagnosed with a urinary tract infection based on a full clinical assessment.
Denominator – the number of adults aged 65 years and over diagnosed with a urinary tract infection.
Data source: Local data collection.
Outcome
Antibiotic prescription rates for urinary tract infections.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services and GPs) ensure that adults aged 65 years and over receive a full clinical assessment before being diagnosed with a urinary tract infection.
Healthcare professionals ensure they perform a full clinical assessment before diagnosing urinary tract infections in adults aged 65 years and over.
Commissioners (such as clinical commissioning groups and NHS England area teams) ensure that all providers are aware that adults aged 65 years and over with a suspected urinary tract infection are diagnosed based on a full clinical assessment. NHS England area teams should be aware that achieving this quality statement could be incorporated into GP surgeries ‘Avoiding Unplanned Admissions’ Enhanced Service, as per local arrangements.

What the quality statement means for patients, service users and carers

Adults aged 65 years and over who have symptoms that are typical of a urinary tract infection have a full clinical assessment before a diagnosis of a urinary tract infection is made.

Source guidance

Definitions of terms used in this quality statement

Symptoms of urinary tract infection
These include dysuria, increased frequency of urination, suprapubic tenderness, urgency and polyuria (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).
Clinical assessment
A full clinical assessment should be a face to face review of the person’s medical history, physical examination, assessment of pulse, blood pressure, temperature and recording of symptoms (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).

Diagnosing urinary tract infections in adults with catheters

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

Quality statement

Healthcare professionals do not use dipstick testing to diagnose urinary tract infections in adults with urinary catheters.

Rationale

Dipstick testing is not an effective method for detecting urinary tract infections in catheterised adults. This is because there is no relationship between the level of pyuria and infection in people with indwelling catheters (the presence of the catheter invariably induces pyuria without the presence of infection). To ensure that urinary tract infections are diagnosed accurately and to avoid false positive results, dipstick testing should not be used.

Quality measures

Structure
Evidence of local arrangements to ensure healthcare professionals do not use dipstick testing to diagnose urinary tract infections in adults with urinary catheters.
Data source: Local data collection.
Process
Proportion of episodes of suspected urinary tract infection in adults with urinary catheters that are investigated using dipstick testing.
Numerator – the number in the denominator assessed using dipstick testing.
Denominator – the number of episodes of suspected urinary tract infection in adults with urinary catheters.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services, care homes and GPs) ensure that training and education programmes are kept up to date so that healthcare professionals do not use dipstick testing to diagnose urinary tract infections in adults with urinary catheters.
Healthcare professionals ensure that dipstick testing is not used to diagnose urinary tract infections in adults with urinary catheters.
Commissioners (such as clinical commissioning groups, NHS England area teams) ensure that providers are aware that adults with urinary catheters should not have urinary tract infections diagnosed by dipstick testing.

What the quality statement means for patients, service users and carers

Adults with urinary catheters do not have urinary tract infections diagnosed by dipstick testing.

Source guidance

Referring men with upper urinary tract infections

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

Quality statement

Men who have symptoms of an upper urinary tract infection are referred for urological investigation.

Rationale

Upper urinary tract infections can indicate the presence of lower urinary tract abnormalities. It is important that men with symptoms of an upper urinary tract infection have urological investigations to ensure that any possible abnormalities are diagnosed and treated.

Quality measures

Structure
Evidence of local arrangements to ensure that men with symptoms of an upper urinary tract infection are referred for urological investigations.
Data source: Local data collection.
Process
Proportion of episodes of suspected upper urinary tract infection in men that are referred for urological investigations.
Numerator – the number in the denominator referred for urological investigations.
Denominator – the number of episodes of suspected upper urinary tract infection in men.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services and GPs) ensure that they have processes in place so that men with symptoms of an upper urinary tract infection are referred for urological investigation.
Health and social care practitioners ensure that they are aware of local referral pathways for urological investigations so that men with symptoms of an upper urinary tract infection can be referred for urological investigation.
Commissioners (such as clinical commissioning groups and NHS England area teams) should seek evidence of practice from providers that men with symptoms of an upper urinary tract infection are referred for urological investigation. This can be achieved through carrying out local audits.

What the quality statement means for patients, service users and carers

Men with symptoms of an upper urinary tract infection are referred to a specialist for urological tests.

Source guidance

Definitions of terms used in this quality statement

Upper urinary tract infection
Characterised by evidence of urinary tract infection with symptoms suggestive of pyelonephritis (loin pain, flank tenderness, fever, rigors or other manifestations of systemic inflammatory response (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).

Urological investigations

These include urodynamic techniques such as pressure/flow cystography to detect lower urinary tract abnormalities (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012], recommendation 5.3).

Urine culture for adults with a urinary tract infection that does not respond to initial antibiotic treatment

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

Quality statement

Adults with a urinary tract infection not responding to initial antibiotic treatment have a urine culture.

Rationale

Some urinary tract infections are resistant to initial antibiotic treatment and a urine culture is needed (or a repeat where an initial urine culture was taken) to determine which antibiotic will work against the specific strain of bacteria causing the urinary tract infection. A urine culture is needed to guide a change in antibiotic treatment in people who do not respond to initial treatment with antibiotics.

Quality measures

Structure
Evidence of local arrangements to ensure adults with urinary tract infections who do not respond to initial antibiotic treatment have a urine culture.
Data source: Local data collection.
Process
Proportion of episodes of a urinary tract infection not responding to initial antibiotic treatment investigated with a urine culture.
Numerator – the number in the denominator investigated with a urine culture.
Denominator – the number of episodes of a urinary tract infection not responding to initial antibiotic treatment.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services and GPs) ensure that processes and referral pathways are in place so that adults with a urinary tract infection not responding to treatment with initial antibiotic treatment have a urine culture.
Healthcare professionals ensure that adults with a urinary tract infection not responding to treatment with initial antibiotic treatment have a urine culture.
Commissioners (such as clinical commissioning groups) ensure that service specifications with local providers indicate that adults with a urinary tract infection not responding to treatment with initial antibiotic treatment have a urine culture.

What the quality statement means for patients, service users and carers

Adults with a urinary tract infection that is not responding to initial antibiotic treatment have their urine tested to see if other antibiotics should be tried.

Source guidance

Definitions of terms used in this quality statement

Urine culture
A sample of urine is taken to identify bacteria and their sensitivity to antibiotics (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).
Not responding
There is no response to treatment within the follow-up period as agreed with the healthcare professional (expert consensus).

Antibiotic treatment for asymptomatic adults with catheters and non-pregnant women

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

Quality statement

Healthcare professionals do not prescribe antibiotics to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women.

Rationale

Antibiotics are not effective for treating asymptomatic bacteriuria in adults with catheters or non-pregnant women. Unnecessary treatment with antibiotics can also increase the resistance of bacteria that cause urinary tract infections, making antibiotics less effective for future use.

Quality measures

Structure
a) Evidence of local arrangements to ensure healthcare professionals do not prescribe antibiotics to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women.
Data source: Local data collection.
b) Evidence of local arrangements to ensure healthcare professionals do not prescribe antibiotics to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women.
Data source: Local data collection.
Process
a) Proportion of episodes of asymptomatic bacteriuria in adults with catheters treated with antibiotics.
Numerator – the number in the denominator treated with antibiotics.
Denominator – the number of episodes of asymptomatic bacteriuria in adults with a catheter.
Data source: Local data collection.
b) Proportion of episodes of asymptomatic bacteriuria in non-pregnant women treated with antibiotics.
Numerator – the number in the denominator treated with antibiotics.
Denominator – the number of episodes of asymptomatic bacteriuria in non-pregnant women.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, community services, care homes, GPs) ensure that processes are in place so that healthcare professionals do not prescribe antibiotics to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women. Internal training and education may be required, according to local need.
Healthcare professionals ensure that antibiotics are not prescribed to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women.
Commissioners (such as clinical commissioning groups, local authorities and NHS England area teams) ensure that providers are aware that antibiotic treatment should not be prescribed to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women. This could be included in local service specifications and pathways.

What the quality statement means for patients, service users and carers

Adults with catheters and non-pregnant women who have bacteria in their urine but no symptoms of urinary tract infection are not prescribed antibiotics.

Source guidance

Definitions of terms used in this quality statement

Asymptomatic bacteriuria
Bacteria in a urine sample taken from a person who does not have any of the typical symptoms of lower or upper urinary tract infection. Asymptomatic bacteriuria should be confirmed by 2 consecutive urine samples (Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network [2012]).

Treatment of recurrent urinary tract infection: placeholder statement

This quality statement is taken from the urinary tract infections in adults quality standard. The quality standard defines clinical best practice in urinary tract infections in adults care and should be read in full.

What is a placeholder statement?

A placeholder statement is an area of care that has been prioritised by the Quality Standards Advisory Committee but for which no source guidance is currently available. A placeholder statement indicates the need for evidence‑based guidance to be developed in this area.

Rationale

Recurrent urinary tract infections are common and it is important that they are managed and prevented effectively.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Offer urodynamic investigations before performing surgical treatments for neurogenic lower urinary tract dysfunction.

Glossary

Paths in this pathway

Pathway created: August 2012 Last updated: March 2017

© NICE 2017

Recently viewed