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Penile, scrotal and testicular abnormalities

Penile, scrotal and testicular abnormalities – Adult

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) 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)

Immediately contact on-call registrar or service to arrange an immediate urology assessment (seen within 7 days) for:

  • Suspected or confirmed testicular tumour

To contact the relevant service, please see HealthPathways: Acute Urology Assessment

Presenting issues
  • 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 referral information (referral will be returned if this information is not included)

History

  • Details of previous treatment and outcome

Investigations

  • MSU or CSU M/C/S (if infective pathology suspected or to be excluded - i.e. testicular swellings/hydrocele)
  • Scrotal USS (if scrotal)

If unable to attach reports, please include relevant information/findings in the body of the referral   

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
Highly desirable referral information
  • STI screening
  • Staging CT scan of the abdomen +/- chest if referring for suspected malignancy
  • Degree of deformity and impact of deformity on sexual function
Indicative triage category
Indicative triage 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)
Excluded urology services

Referral to public adult urology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Scrotal abnormalities

 Excluded condition for the following:

  • Minimally symptomatic (ie. not impairing quality of life) /asymptomatic epididymal cyst, hydrocele or varicocele identified through ultrasound
  • See HealthPathways: Urology
 Penile discharge
Last reviewed: 05-01-2024
wa.gov.au