Delayed referral to a renal specialist adversely affects patient outcomes. This study suggests that the implementation of a virtual renal clinic for non-complex renal pathologies can offer a cost-effective, rapid referral mechanism for patient assessment combined with readily available specialist advice.

The normal male external genitalia include the testicles with the epididymis attached posteriorly and the vas deferens arising from this. This case describes an anatomical variation of this normal anatomy not previously reported in the literature. A 17-year-old boy presented with symptoms of intermittent testicular torsion and underwent scrotal exploration. On the left side there was a bell-clapper deformity with the epididymis separated into two parts with the lower pole high in the scrotum and attached to the tunica vaginalis. A normal vas deferens was seen to arise from the isolated lower pole of the epididymis. There was no connection between the vas deferens and the testis or upper pole of epidiymis. This case reminds us of the possibility of anatomical variations and the importance of keeping them in mind to prevent complications at time of surgery.

Background: Straight to test (STT) is a recognised pathway for improving the two week waiting time targets for red flag referrals.2,4-6 However STT relies on Telephone Assessment Clinics (TAC) by clinicians or specialist nurse practitioners when determining suitability of referred patients for investigations.4-7 Electronic patient care records (ECR) provide clinicians with a greater volume of clinical information allowing virtual triage and STT with a reduced dependence on TAC therefore improving waiting time for tests and treatment. Methods: A retrospective review of 300 colorectal referrals was performed. Patients awaiting an appointment were reviewed electronically, using ECR, by a single colorectal surgeon and re-triaged STT if appropriate. The delay in time from the referral to initial review was removed to create a second group for statistical comparison to demonstrate time saved if the strategy was adopted at point of original triage. Data was analyzed using SPSS. Results: 300 colorectal referrals were reviewed between February 5th 2018 and July 22nd 2019. 91.3% (n= 274) were red flag, 7% (n= 21) urgent and 1.7% (n=5) routine. 94% (n=282) were sent straight to test. Red flag patients processed via traditional referral and clinic had a median time to scope of 36 days (IQR = 55 days) compared with 22.5 days (IQR = 19.75 days), p < 0.001 if triaged straight to test via virtual clinic. Median time to management for red flag patients was 59 days (IQR = 63.5 days) for traditional and 35 days (IQR 51.5 days) for STT, p < 0.001. 71.7% of patients (n=215) required no follow up clinic appointment. Conclusion: Straight to test using ECR is a safe and effective means of triage and is a useful tool when incorporating STT access for colorectal referrals in order to reduce waiting times for tests and treatments.