Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute scrotal pain/torsion of the testes
  • foreign bodies
  • paraphimosis/phimosis causing urinary retention
  • priapism
  • severe genital infection e.g. Fournier’s gangrene/epididymo-orchitis
  • unreducible paraphimosis
  • testicular mass

Please contact the urology registrar on call to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • chronic testicular pain previously evaluated with urology – please refer to chronic pain
  • erectile dysfunction unrelated to surgical treatment for prostate or colorectal cancer
  • hypogonadism – refer to endocrinology
  • Peyronie's disease
  • sexually transmitted infections – refer to Adelaide Sexual Health Centre
  • specialist services in SA Health do not offer circumcision for cultural/religious reasons

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy – scrotal imaging. Contact the urology registrar on call to discuss your concerns prior to referral
  • suspected malignant penile lesion

Category 2 (appointment clinically indicated within 90 days)

  • painful swollen testis/epididymis, provided testicular cancer has been excluded
  • recurrent balanitis/posthitis
  • paraphimosis

Category 3 (appointment clinically indicated within 365 days)

  • phimosis with failed trial of first-line treatment with normal imaging
  • scrotal pain or swelling with normal imaging and any of the following:
    • hydrocele/varicocele
    • other foreskin abnormalities (frenulum breve, scarring and tearing)
    • chronic epididymo-orchitis
    • painful or large epididymal cyst

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • relevant past medical/surgical history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features e.g., concerns of malignancy for penile lesions
    • previous treatments trialled e.g., trial of steroid cream for phimosis
  • physical examination findings
    • scrotal and penis examination
  • relevant diagnostic/imaging reports (including location of company and accession number)
  • concerns of testicular mass
  • pathology:
    • alpha-fetoprotein (AFP)
    • human chorionic gonadotropin (HCG)
    • lactate dehydrogenase (LDH)
    • urine cytology, may help to prioritise referral
  • scrotum/testis ultrasound (US) urgent but should not delay referral

Pathology

  • complete blood examination (CBE)
  • electrolytes, urea and creatinine (EUC)
  • liver function test (LFT)
  • estimated glomerular filtration rate (eGFR)
  • mid-stream urine (MSU) M/C/S
  • sexually active people, complete a sexually transmitted infection (STI) screen which including chlamydia and gonorrhoea which requires:
    • penile swab for culture and
    • penile polymerase chain reaction (PCR) swab or urine sample

Additional information to assist triage categorisation

  • chest-abdomen-pelvis (CAP) staging computed tomography (CT)

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.