A Review of Referrals for Suspected Testicular Malignancy Mr Jonathan Harikrishnan ST3 Urology

Testicular Cancer Increasing incidence throughout the UK Two week wait referral process Current guidelines suggest: Urgent referral in any patient with a swelling or mass in the body of the testis An urgent ultrasound to be performed if it does not transilluminate or where the body of the testis cannot be distinguished

Aims Our primary aim was to review our data for referrals made to our department for testicular malignancy looking at the range of patients referred and if the referrals were appropriate. To look for ways to improve the referral process

Methods 12 months of data from August 2009 – August 2010 Data collected on Patient age Date of referral Date seen in clinic Presentation Investigation Diagnosis Outcome

Referrals 123 DNA 6 Seen in Clinic 117 Inappropriate 4 Non malignant findings 96 Testicular tumour 17 USS Benign 3 Malignant 14 Results

100 patients had benign pathology Cysts, Infection, Post vasectomy change, Hydrocele, Varicocele 17 underwent orchidectomy 3 with benign pathology 14 with malignancy Only 6 had ultrasound scans prior to clinic Four referrals deemed inappropriate

Discussion High numbers of patients with benign pathology referred urgently Can this number be reduced? Could guidelines be more specific? One stop clinic… Further education The next step…

Take home message We are still seeing high numbers of patients with benign pathology under the two week wait In the current economic climate inappropriate referrals are already a burden on a tight schedule of two week wait reviews and if we can reduce their number this service can continue to function effectively