Category
Threshold Criteria
Asymptomatic scrotal swelling is the incidental finding of a swelling or lump that may be associated with minor discomfort. This policy excludes all acute and painful scrotal swelling and inguinal/-scrotal herniae.
Eligibility
| LLR ICB will support referral and treatments for the following  Primary Care Refer:  – Painful varicoceles affecting quality of life  – children <16 years to a paediatric surgical service   – all uncertain scrotal swellings for routine USS and await results before referral  Following USS: ·      if a suspected malignancy is found, refer on 2 week wait to urology ·      reassure patients with Hydrocoele/ Varicocoele/ Epididymal Cyst ·      only consider repeat USS if there is significant clinical changes ·      patients should be directed to appropriate supporting information e.g. NHS Choices, patient.co.uk  Secondary Care  Varicocoeles in adults who have undergone primary care management outlined above:  ·      consider embolisation in Men who are having difficulties conceiving with reduced semen parameters  However, procedures on varicocoeles are not routinely recommended as a treatment for infertility in adults as they do not improve pregnancy rates   Varicocoeles in adolescents: with ipsilateral testicular size reduction   However Varicoceles become more frequent in at the beginning of puberty. Fertility problems will arise in about 20% of affected adolescents. Varicocelectomy embolisation is indicated for those patients with a small testis (growth arrest) as testicular catch up growth and improvement in sperm parameters has been reported |
Guidance
| Commissioning Guide:Â Asymptomatic Scrotal Swelling, BAUS, 2013 Â Scenario: Management | Management | Varicocele | CKS | NICE |
| ARP 86 Review Date: 2026 |
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