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Penile, scrotal and testicular abnormalities Referral Access Criteria

Penile, scrotal and testicular abnormalities Referral Access Criteria

Referrers should use this page when referring patients to public adult urology outpatient services for penile, scrotal and testicular abnormalities.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Torsion of the testes
  • Acute scrotal pain only with suspicion of torsion.
  • Severe scrotal infection concerning for Fournier’s gangrene
  • Acute paraphimosis (if unable to reduce in primary care)
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
  • Suspected or confirmed testicular tumour
To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Scrotal mass
  • Painful swollen testis or epididymis
  • Symptomatic hydrocele
  • Symptomatic varicocele
  • Intermittent testicular pain suggestive of intermittent testicular torsion
  • Chronic or recurrent scrotal pain
  • Haematospermia (isolated Haematospermia is usually benign)
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Details of previous treatment and outcome 
Examination
  • Nil
Investigations
  • Scrotal USS (if scrotal)
  • MSU or CSU M/C/S (if infective pathology suspected or to be excluded- i.e. testicular swellings/hydrocele)            
Highly desirable
History
  • Degree of deformity and impact of deformity on sexual function           
Examination
  • Nil
Investigations
  • STI screening
  • Staging CT scan of the abdomen +/- chest if referring for suspected malignancy
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Painless, solid, testicular mass or swelling suspicious of testicular cancer
  • Suspected penile cancer or tumour
  • Metastatic germ cell tumours (require both Urology and Oncology input)            

Category 2

Appointment within 90 days

  • Intermittent testicular pain suggestive of intermittent testicular torsion
  • Painful swollen testis/epididymis provided testicular cancer has been excluded
  • Haematospermia
  • Foreskin phimosis with voiding obstruction/threatened paraphimosis
  • Penile discharge (if STI has been excluded and urological issue is suspected)           

Category 3

Appointment within 365 days

  • Scrotal pain or swelling and any of the following:
    • hydrocele/varicocele
    • painful or large (>5cm) epididymal cyst
  • Foreskin phimosis provided no obstructed voiding
  • Erectile dysfunction (post-surgical) not responding to maximal medical management (ie. PDE5 inhibitors, prostaglandin E1
  • intracavernosal injection)
  • Peyronie’s disease causing functional impairment or pain
  • Chronic (>3 months) testicular pain
  • Other foreskin abnormalities (frenulum breve, scarring and tearing)
Exclusions
  • Nil
Useful information
  • Nil

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Last reviewed: 05-01-2024
wa.gov.au