Crawley/Horsham Primary Care Pathways
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Crawley/Horsham Primary Care Pathways. Non Acute Scrotal Swelling. Differential Diagnosis: Hydrocoele Varicocele Epididymal Cyst Thickened EpididymisSpermatocele (Post Vasectomy) Sebaceous Cyst. Consider: History of trauma Urethral Discharge – Epididymitis

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Crawley/Horsham Primary Care Pathways

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Crawley horsham primary care pathways

Crawley/Horsham Primary Care Pathways

Non Acute Scrotal Swelling

  • Differential Diagnosis:

  • Hydrocoele

    • Varicocele

  • Epididymal Cyst

  • Thickened EpididymisSpermatocele (Post Vasectomy)

  • Sebaceous Cyst

  • Consider:

    History of trauma

    Urethral Discharge – Epididymitis

    Maldescent or atrophied testis

    Frequent self-examination

    PossibleTorsion

    Possible Testicular

    lesions (consider

    differential diagnosis)

    Definite clinically

    suspicious

    testicular lesion

    2 Week Rule

    Urgent referral

    to duty

    hospital urologist

    GP confident clinical presentation

    epididymal cyst reassure patients

    Refer to secondary

    care urologist

    If patients symptomatic or GP

    unsure of diagnosis, request

    Scrotal ultrasound scan

    Ultrasound

    Direct access ultra

    sound at Crawley

    Referral option: LSUS

    for ultrasound

    and management plan

    • Referral option: LSUS

    • Management Options may include:

    • Excision epididymal }

    • cyst where

    • Hydrocelectomy } indicated

    • Varicocelectomy }

    Developed by: Dr Raj Sinha and Mr Waleed Al-Singary

    V1.0 18/7/11


    Crawley horsham primary care pathways

    Crawley/Horsham Primary Care Pathways

    • Management options could

    • Include:

    • Urodynamics /CMG

    • Uroflowmetry

    • Ultrasound of Bladder, Kidney and Prostate

    • Further medical management

    Male Lower Urinary Tract Symptoms

    • Storage Symptoms

    • Frequency

    • Urgency

    • Nocturia

    • Urge Incontinence

    • Voiding Symptoms

    • Hesitancy

    • Poor, intermediate flow

    • Post-voiding dribbling

    Mixed Symptoms

    • Investigations

    • Dipstick +ve for blood

    • Suspiciously raised PSA

    • Abnormal DRE

    • MSU +ve for infection

    Refer to

    Secondary

    care Urologist

    • Severe Storage Symptoms

    • Recent nocturnal enuresis

    • Suspected neurogenic bladder

    • Previous acute retention

    • Previous TURP/pelvic surgery

    NO

    Age >50

    Age < 50

    IF normal DRE, PSA U&E then try Tamsulosin MR capsules for 4 weeks.

    Referral option: LSUS

    If no

    better

    Developed by: Dr Raj Sinha and Mr Waleed Al-Singary

    V1.0 18/7/11


    Crawley horsham primary care pathways

    Crawley/Horsham Primary Care Pathways

    Erectile Dysfunction

    • History

    • Medical

    • Sexual

    • Psychological

    • Drugs

    • Examination

    • Secondary sexual characteristics

    • Genital Examination

    • (Deformities, foreskin problems, shaft nodules)

    • Blood Pressure

    • Blood Tests

    • Glucose

    • Lipids profile

    • Testosterone

    • Urological Problems indentified

    • Low testosterone

    • Genital abnormalities

    • Peyronie’s disease

    • Premature ejaculation

    • Cardiovascular Risk factors

    • Treat risk factors

    • If no contraindications, Trial ED

    • drugs. Try 2 different drugs for

    • at least 2 months (Beware of

    • NHS guidelines Regarding

    • prescription ED drugs)

    • Psychosexual

    • Suggested by

    • Psychological history

    • Sudden onset of ED

    • Normal early morning

    • erections

    • Normal erections with masturbation

    • ± Try Sildenafil orVardenafil for 4 weeks

    • Referral option: LSUS

    • Management Options

    • to include:

    • 3rd line medication

    • Suction pump

    • Caverjet Injection

    • Low testosterone

    • Sildenafil + Testosterone

      • Gel

      • Patches

      • Injections

      • Implant

    Failure of treatment

    Trial ED drugs as one-off treatment for 1 month max.

    Developed by: Dr Raj Sinha and Mr Waleed Al-Singary

    V1.0 18/7/11


    Crawley horsham primary care pathways

    Crawley/Horsham Primary Care Pathways

    Chronic Scrotal Pain

    • Intermittent or constant scrotal pain for 3 or more months

    • Significantly interferes with daily activity

    • Prompts request for medical advice

    • Consider :

    • Idiopathic

    • Infective or post infective

    • Post vasectomy

    • Chronic Prostatitis

    • Neuromuscular disorder

    • Psychosomatic

    Urine dipstick

    MSU

    All negative

    No discharge

    Refer to Secondary

    Care Urologist

    Positive

    Ultra sound

    Dipstick & MSU positive

    Urethral discharge

    Direct Access

    ultrasound at

    Crawley Hospital

    Referral option: LSUS

    for U/S and

    management plan

    Age < 35

    Age > 35 and

    change in

    sexual lifestyle

    Age > 35 and no

    change in

    sexual lifestyle

    Refer GUM

    • Management may include:

    • Neuropathic medication

    • Spermatic cord de-nervation

    • Epididymectomy

    • Orchidectomy

    Need Flexicystoscopy

    Developed by: Dr Raj Sinha and Mr Waleed Al-Singary

    V1.0 18/7/11


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