Scrotal conditions

Urgent Suspicion of Cancer Criteria

• Non-painful enlargement or change in shape or texture of body of testis
• Epidiymo-orchitis not improving after 2 weeks of treatment
• USS suggestive of testicular cancer

Consider

• Duration of symptoms
• Pain
• Urinary symptoms
• Risk of STI
• Mumps

Examination

• Side and size
• Can you feel the testis separately?
• Is the testicle hard and or abnormally shaped?
• Does it transilluminate?

Refer as emergency to on-call urology team

Investigations

• Send MSSU
• Consider cultures for chlamydia and Gonorrhoea if appropriate
• Treat with antibiotics
• If low risk of gonorrhoea i.e. no discharge
• Antibiotics e.g ofloxacin, recommended duration 2 weeks GGC Medicines: Quinolones
• If Gonorrhoeal acute epididymitis suspected refer to Sandyford
• If not settling within 2 weeks request US testis to exclude other pathology and/or consider USOC refferal

• Note ultrasound is not routinely indicated for extra-testicular lump with normal testes on exam, as these are more likely benign.
• When considering the below pathologies request and review USS before referring scrotal pathology
• If normal USS with scrotal pain there is very little a urologist will offer

• Do not refer if patent asymptomatic
• Refer routine urology if patient wishes to consider surgery

• Do not refer if patent asymptomatic
• Refer routine urology if patient wishes to consider surgery

• Palpable while standing and pain
• Palpable while standing and concerns about fertility status
• Signs of testicular atrophy
• Refer routine urology

• GGC, Greater Glasgow and Clyde
• OP, outpatient
• PO, by mouth
• US, ultrasound
• USOC, urgent suspicion of cancer
• UTS, urinary tract symptoms.

1. NICE. Scrotal pain and swelling. August 2024. Available at: cks.nice.org.uk/topics/scrotal-pain-swelling/diagnosis/assessment/ (Accessed: January 2025)
2. CfSD. Scottish Referral Guidelines for Suspected Cancer 2024 Full Clinical Review (Draft). December 2024.