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Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 Crawley/Horsham Primary Care Pathways Non Acute Scrotal Swelling Differential Diagnosis:

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Presentation on theme: "Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 Crawley/Horsham Primary Care Pathways Non Acute Scrotal Swelling Differential Diagnosis:"— Presentation transcript:

1 Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 Crawley/Horsham Primary Care Pathways Non Acute Scrotal Swelling Differential Diagnosis: Hydrocoele Varicocele Epididymal Cyst Thickened Epididymis Spermatocele (Post Vasectomy) Sebaceous Cyst Consider: History of trauma Urethral Discharge – Epididymitis Maldescent or atrophied testis Frequent self-examination Possible Torsion Urgent referral to duty hospital urologist Possible Testicular lesions (consider differential diagnosis) GP confident clinical presentation epididymal cyst reassure patients 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 } Definite clinically suspicious testicular lesion 2 Week Rule Refer to secondary care urologist

2 Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 Crawley/Horsham Primary Care Pathways Male Lower Urinary Tract Symptoms Voiding Symptoms Hesitancy Poor, intermediate flow Post-voiding dribbling Storage Symptoms Frequency Urgency Nocturia Urge Incontinence Mixed Symptoms Severe Storage Symptoms Recent nocturnal enuresis Suspected neurogenic bladder Previous acute retention Previous TURP/pelvic surgery Refer to Secondary care Urologist NO Investigations Dipstick +ve for blood Suspiciously raised PSA Abnormal DRE MSU +ve for infection IF normal DRE, PSA U&E then try Tamsulosin MR capsules for 4 weeks. Referral option: LSUS Management options could Include: Urodynamics /CMG Uroflowmetry Ultrasound of Bladder, Kidney and Prostate Further medical management If no better Age < 50 Age >50

3 Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 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 Psychosexual Suggested by Psychological history Sudden onset of ED Normal early morning erections Normal erections with masturbation ± Try Sildenafil orVardenafil for 4 weeks 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) Urological Problems indentified Low testosterone Genital abnormalities Peyronie’s disease Premature ejaculation Trial ED drugs as one- off treatment for 1 month max. Failure of treatment Referral option: LSUS Management Options to include: 3 rd line medication Suction pump Caverjet Injection Low testosterone Sildenafil + Testosterone -Gel -Patches -Injections -Implant

4 Developed by: Dr Raj Sinha and Mr Waleed Al-Singary V1.0 18/7/11 Need Flexicystoscopy Urine dipstick MSU All negative No discharge Ultra sound Positive Refer to Secondary Care Urologist Dipstick & MSU positive Urethral discharge 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 Age < 35 Age > 35 and change in sexual lifestyle Refer GUM Age > 35 and no change in sexual lifestyle Direct Access ultrasound at Crawley Hospital Referral option: LSUS for U/S and management plan Management may include: Neuropathic medication Spermatic cord de-nervation Epididymectomy Orchidectomy


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