Retention, routed immediately
Inability to pass urine with suprapubic pain and a palpable bladder is an urgent catheterisation, not an appointment. Routed to the service or to emergency care with the duration and volume history recorded.
Specialty · Urology
Retention and haematuria sorted from the rest of the queue.
Urology triage with retention and visible haematuria thresholds, catheter care and blocked-catheter protocols, PSA pathway coordination, and post-procedure follow-up.
- < 45s
- Retention to urgent routing
- 78%
- Catheter problems resolved by phone
- 3.0x
- PSA pathway contacts per week
In the product
Urology line — inbound 15:32
Fast-trackedInbound 15:32 · Gerard H. · 57 · smoker · no urological history
Caller
I passed blood this morning. Bright red. It only happened once and there was no pain, so I nearly didn't ring.
Primum
You were right to ring. Has it happened before, and are you on any blood thinners?
Caller
Never before. No thinners.
Painless visible haematuria, single episode → suspected cancer pathway, any age
Primum
Even one episode without pain needs investigating properly, and that's true even if it never happens again. I'm putting you on an urgent pathway — you'll be contacted within five working days.
Pathway record
- Presentation
- Visible haematuria, painless
- Episodes
- 1 · this morning
- Anticoagulated
- No
- Risk factors
- Current smoker, 30 pack-year
- Pathway
- Suspected urothelial cancer
- Contact due
- Within 5 working days
Referral assembled 15:38 · history attached · patient informed of timeline
Overview
Two urology presentations cannot wait, and both sound like a plumbing complaint.
- Retention and visible haematuria routed on the first two answers.
- Catheter problems triaged by protocol, with most resolved without a district nurse visit.
- PSA pathway, biopsy preparation and post-procedure follow-up coordinated end to end.
Acute urinary retention is painful, common and urgent. Visible haematuria is painless, easy to dismiss, and one of the strongest single predictors of urothelial cancer there is. Both arrive on a line otherwise full of catheter questions, flow symptoms and PSA queries.
Primum separates them on the first answers: can you pass urine at all, is there blood you can see, how long, is there pain. Retention routes urgently. Visible haematuria goes onto the two-week pathway with the history assembled. The catheter work — blockages, bypassing, leg bag problems, trial without catheter scheduling — is protocolised and mostly resolved on the call.
Capabilities
Four urology workstreams
Two are urgent pathways, two are the volume the service runs on.
Visible haematuria fast-tracked
Painless visible haematuria at any age triggers the suspected cancer pathway with smoking history, occupational exposure, anticoagulation status and prior episodes assembled.
Catheter protocols
Blockage, bypassing, bleeding, leg bag and night bag problems, and trial without catheter scheduling — with the flushing and troubleshooting steps a patient can do themselves before anyone is dispatched.
PSA and biopsy pathways
Result explanation in plain language, repeat testing intervals, biopsy preparation including antibiotic and anticoagulation instructions, and post-biopsy sepsis safety-netting.
How it works
Two questions that sort the queue
Everything else follows from whether they can pass urine and whether there is visible blood.
- Arrives
- Decided
- Done
- Returned
01
Call opens
Patient matched with urological history, catheter status, recent procedures and PSA history loaded.
Urology context
02
Retention and blood checked
Ability to void, pain, duration, and visible haematuria established before any other symptom is discussed.
First-line questions
03
Pathway assigned
Urgent catheterisation, suspected cancer pathway, catheter protocol or routine review, with findings coded and verified.
Pathway criteria
04
Resolved or routed
Catheter troubleshooting completed on the call, or the referral assembled and the patient told what happens next and when.
Referral + chart
01
Call opens
Patient matched with urological history, catheter status, recent procedures and PSA history loaded.
Urology context
02
Retention and blood checked
Ability to void, pain, duration, and visible haematuria established before any other symptom is discussed.
First-line questions
03
Pathway assigned
Urgent catheterisation, suspected cancer pathway, catheter protocol or routine review, with findings coded and verified.
Pathway criteria
04
Resolved or routed
Catheter troubleshooting completed on the call, or the referral assembled and the patient told what happens next and when.
Referral + chart
Benefits
Urgency identified, routine handled
The specialty's volume is catheters; its risk is elsewhere.
Cancer pathways start on day one
Visible haematuria recognised and referred on the day of contact rather than after a routine appointment and a urine dipstick.
Fewer nurse visits for catheters
Most catheter problems have a troubleshooting sequence the patient or a family member can follow. Walking them through it resolves the majority without a visit.
PSA results explained once
A result explained properly with the next step booked prevents the three follow-up calls that a number in a letter generates.
In practice
Four urology calls
The one the patient was least worried about is the one that matters most.
Blood, once, no pain
Two-week pathwayPainless visible haematuria on one occasion. Referred on the suspected cancer pathway with smoking and occupational history attached.
Cannot pass urine, 8 hours
Urgent, 40sSuprapubic pain and a distended bladder. Routed for urgent catheterisation with duration and last void recorded.
Catheter bypassing
Resolved on callBypassing around the catheter with a distended bag tube. Kink identified and corrected on the call, with a follow-up check scheduled.
PSA 6.8 at 61
Explained, bookedResult explained with context on free ratio and prior values, and a urology appointment booked with preparation information sent.
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Look at your haematuria referrals
Ask how many started with a call where the patient nearly did not ring. We will run the triage over a month of urology contacts and show you what would have been fast-tracked on the day.