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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)
  • Epididymitis with systemic features e.g. fever 
  • Acute testicular trauma (e.g. severe blunt trauma with ongoing pain +/- bruising, degloving injury, penetrating injury, testicular rupture, testicular dislocation) 
  • Urethral foreign body 
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 (non-malignant)
  • Chronic or recurrent scrotal pain
  • Penile lesion
  • Phimosis
  • Recurrent balanoposthitis
  • Symptomatic hydrocele
  • Sub-acute painful swollen testis or epididymis
  • Intermittent testicular pain suggestive of inter 
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
  • Relevant history, onset, duration and severity of symptoms
  • Details of previous treatment and outcome
  • Degree of deformity and impact of deformity on sexual function
  • Current medication list
  • Any known allergies  
Examination
  • Nil
Investigations
  • If scrotal: scrotal ultrasound (US)        
Highly desirable
History
  • Nil         
Examination
  • Nil
Investigations
  • MSU (or CSU) MCS
  • STI screening
  • If testicular tumour suspected: tumour markers (serum bHCG, LDH, and alpha fetoprotein (AFP))
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Suspected penile cancer or tumour           

Category 2

Appointment within 90 days

  • Testicular pain suggestive of recurrent episodes of self-resolving intermittent testicular torsion
  • Painful swollen testis/epididymis provided testicular cancer has been excluded on ultrasound
  • Foreskin phimosis with voiding obstruction/threatened paraphimosis
        

Category 3

Appointment within 365 days

  • Scrotal pain or swelling and any of the following:
    • hydrocele/varicocele
    • painful or large (>5cm) epididymal cyst
  • Penile discharge (if STI has been excluded and urological issue is suspected)
  • Other foreskin abnormalities (frenulum breve, scarring and tearing) requiring surgery for medical reasons
  • Post-surgery erectile dysfunction
  • Peyronie’s disease causing functional impairment or pain 
  • Chronic (≥3 months) testicular pain
  • Varicoceles associated with infertility
Exclusions
Useful information
  • Nil

Feedback

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Last reviewed: 29-04-2025
wa.gov.au