Prospective evaluation of a novel one-stop testicular clinic

Abstract

Introduction: In 2003, the waiting time for routine scrotal assessment approached 6 months in our hospital. The patients' diagnostic pathway was not uniform and involved several delays between general practitioner, radiologist and urologist. If malignancy was suspected, patients were seen and assessed within 2 weeks. However, it was possible for patients with unsuspected malignancy to have their diagnosis delayed.

Patients and methods: Funding was provided by the NHS Modernisation Agency's Action On Urology project. Men who were referred by their general practitioner (GP) with a testicular or scrotal condition would be reviewed in a one-stop joint sonographer and urology nurse specialist clinic provided entirely within the urology department with rapid open access. Data were prospectively collected for 2 years. Source of referral, suspected diagnosis, findings and outcome were recorded.

Results: A total of 1017 patients attended the clinic over this period; of these, 203 (4%) were referred under the '2-week wait' criteria. Of patients attending the clinic, 79% were discharged to GP care, 8% were added to the waiting list for a surgical procedure and 20% were referred with 'testicular lump'. Eleven patients were suspected to have testicular tumour on ultrasound and proceeded to orchidectomy in this period. One patient (0.1%) was found to have an unsuspected seminoma. The waiting time for all scrotal ultrasound examinations has fallen from 22 to 2 weeks. The waiting times for intravenous urography and general ultrasound were also significantly reduced following the introduction of this service (P = 0.005).

Conclusions: The majority of patients passing through this clinic are the 'worried-well' with benign scrotal pathology. They can now be seen within 2 weeks regardless of whether their GP suspects testicular tumour. This reduces anxiety in this large group of patients freeing capacity elsewhere in the diagnostic imaging department.

Figure 1

GP referrals to one-stop service per month.

Figure 2

Final outcome of cohort of 1017 patients.

Figure 3

Outcome destination in the indirect supervision period.

Figure 4

Waiting times for radiological investigations. Mean (SD) monthly wait for (A) IVU, (B) general ultrasound, and (C) CT scan displayed per 3-month (quarter) period.

Figure 4

Waiting times for radiological investigations. Mean (SD) monthly wait for (A) IVU, (B) general ultrasound, and (C) CT scan displayed per 3-month (quarter) period.

Figure 4

Waiting times for radiological investigations. Mean (SD) monthly wait for (A) IVU, (B) general ultrasound, and (C) CT scan displayed per 3-month (quarter) period.