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REMEDY : BNSSG referral pathways

Penile Disorders – General Guidance

Checked: 14-11-2018 by Rob.Adams Next Review: 14-11-2019

Penile Pain

Penile pain – if examination is normal and no evidence of Peyronies or urethral stricture then referral to urology usually unnecessary. Consider pain relief meds or psychosexual therapy.

Peyronie's Disease

Peyronie's disease can present with a variety of symptoms including:

  • Penile pain during erections
  • Penile angulation
  • Palpable fibrous plaque in shaft of penis
  • Erectile dysfunction

The condition can be self-limiting so local urologists have advised to only consider referral if the patient has had symptoms for at least 6 months. Vacuum pump therapy can be useful to prevent progression and may be considered as an alternative to surgery in some men.  Peyronie's can be associated with diabetes and this should be excluded.

Further advice  can be found on the Peyronie's disease page of the patient.info website.

Phimosis

In boys less than 10 years then this is usually physiogical and will resolve without treatment. In children 10 years and over and adults then referral for circumcision may be indicated. In either case referral for circumcision is subject to prior approval policies as below:

Penile Conditions (including circumcision) for adults aged 18 and over.

Penile Conditions (including circumcision) for children aged 17 and under.

 

Referral

For penile conditions which fall under funding policies please obtain prior approval before referring.

Referrals should be submitted via eRS.

If advice is required about appropriateness of referral then please consider using the Urology Advice and Guidance service available via eRS.

Sexually Transmitted Infections

For advice on assessment and treatment of suspected infections affecting the penis please see the Sexual Health Guidelines section of Remedy.

For genital lumps the following is recommended under the Unity Sexual Health FAQs section :

‘I’m unsure of diagnosis of a genital lump, how do I refer the patient to you for second opinion?

Red Flags

Red flags for suspected cancer  - see below and  Urology 2WW section

  • A penile mass or ulcerated lesion where a sexually transmitted infection has been excluded.(This includes progressive ulceration or a mass particularly in the glans penis or prepuce, but can involve the skin of the penile shaft. For lumps within the corpora cavernosa that do not involve the penile skin, please use the routine referral process.)
  • A persistent penile lesion after treatment for a sexually transmitted infection has been completed.
  • Unexplained or persistent symptoms affecting the foreskin or glans (This does not include simple phimosis. Please ensure fungal infections and balanoposthitis have been excluded or treated before considering referral.)