Scrotal Conditions

Who to refer:

• Refer to Emergency On-Call Urology Team for Suspected testicular torsion
• Refer to Sexual Health for Suspected epididymo-orchitis where gonorrhoea is suspected
• Refer to Urology as USOC (see below) if US report is suspicious of cancer.
• Refer to Urology (see below) for Testicular pain not responding to antibiotics
• Refer for Ultrasound. Ultrasound is indicated for:
  • Intra-testicular lump, or diffusely swollen testis
  • Scrotal lump, if uncertain whether it is intra- or extra-testicular
  • New hydrocele, if the underlying testis cannot be palpated as normal.
  • Clinically suspected varicocele where referral to Urology is anticipated
• Ultrasound is not routinely indicated for
  • Extra-testicular lump with normal testes on examination, e.g. epididymal cyst
  • Subcutaneous lumps

Who not to refer:

• Epidymo-orchitis (with no suspected gonorrhoea) which settles with antibiotics
• Varicocele / hydrocoele / epididymal cyst where surgery not wished.

How to refer:

For patients where Testicular Cancer is suspected:

• Refer to Radiology for Ultrasound:

SCI GATEWAY > ELCH or LB or Leith CTC or RIE or SJH or WGH > Clinical Radiology > LI Radiology Ultrasound. In the referral select Ultrasound Testes and check priority USOC

• Onward Referral to Urology

SCI GATEWAY > WGH > LI Scrotal Swelling (selecting USOC as priority)

Where the US is reported as suspicious for testicular cancer the report will be emailed by radiology to the Clinical Inbox of the referring GP practice and will require the GP to inform the patient and to send a USOC SCI Gateway referral. It will also be emailed to the Testicular cancer clinic. The GP email will contain the following information along with the US report:

Dear GP,

URGENT EMAIL, GP ACTION REQUIRED

Please see the report below. I would be grateful if you could inform the patient of the result, warn the patient to expect an urgent appointment and send a formal USOC referral to Urology via SCI Gateway:

SCI GATEWAY > WGH > LI Scrotal Swelling (selecting USOC as priority)

This email is being sent to the Practice Clinical Inbox and will also be emailed to the Urology Testicular Cancer Clinic (email address). A SCI GW referral is still needed.

All other scrotal conditions that require a referral

SCI GATEWAY > WGH > LI Scrotal Swelling (selecting appropriate priority)

Radiology Update June 2022