Urologist led one-stop testicular clinic: the UK 'gold standard’

Abstract

Prompt diagnosis and early treatment for testicular cancer is vital. To help with this a one-stop, urologist run, testicular clinic with testicular ultrasound scanning as an integral part of the clinic format was introduced to investigate patients in an efficient and timely manner. The aim of this study was to assess the feasibility and efficiency of running a one-stop testicular clinic. A prospectively collected electronic database of all patients attending a one-stop testicular clinic at a busy university hospital was interrogated over a 6-year period. Only new referral males, above the age of 15 years old were included. Case notes were reviewed retrospectively. A total of 1757 patients were found with a median age of 36. 6.3 % had a suspicious ultrasound scan and overall 5.6 % were found to have malignancy histologically. In addition a significant proportion of men with a history of testicular maldescent went on to develop testicular cancer (p < 0.01). Median time from referral to clinic and clinic to orchidectomy for suspected testicular cancers was 9 and 5 days respectively (95 % CI). Some of the benefits of a urologist run one-stop testicular clinic include: timely diagnosis and treatment, early reassurance with normal investigations, the discovery of clinically unsuspecting malignancy and the increase in teaching opportunities. These collective benefits must improve patient experience and benefit the department as a whole. A urologist led one-stop testicular clinic should be regarded as the gold standard.

A patient‐centric pathway for testicular cancer – A multicentre study investigating the uptake of semen cryopreservation and impact on treatment

“…The diagnostic sensitivity of scrotal ultrasound approaches 100%; however, the specificity can vary and is around 90% 27,28 . We report the same rate of benign histology following a scrotal USS to another UK specialist‐led one‐stop clinic, nearly 10% 28 . Where scrotal USS was highly suggestive of testicular cancer, the false‐positive rate was just under 6% in our cohort.…”

“…Where both the scrotal USS and clinical diagnosis were suggestive of malignancy, the median time to CT was 7 days in comparison to 10 days where either clinical examination or USS was inconclusive, representing an appropriate delay for consideration of different pathologies. The diagnostic sensitivity of scrotal ultrasound approaches 100%; however, the specificity can vary and is around 90% 27,28 . We report the same rate of benign histology following a scrotal USS to another UK specialist‐led one‐stop clinic, nearly 10% 28 .…”

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes

“…there were no clinics that accepted referrals where there was a general suspicion of cancer. The indications for referral included: seven studies on post-menopausal or abnormal vaginal bleeding (20)(21)(22)(23)(24)(25)(26), six studies on breast symptoms (14,15,(27)(28)(29)(30), three for lower gastrointestinal (GI) symptoms (16,31,32), three for elevated prostate specific antigen (PSA) (17,18,33), three for testicular symptoms (34)(35)(36), two for urological symptoms (37,38), two for dyspepsia (39,40), one for haematuria (19), one for unexplained lymphadenopathy (41), and one for neck lumps (6). When reported, one-stop clinics were held in a hospital setting.…”

Testicular cancer: improving outcomes with national quality performance indicators

“…A similar scheme has been introduced in Birmingham, UK, and has been shown to produce a median time from clinic to having an orchidectomy of 5 days. 15 A further example can be seen in the QPI based on the quality of adjuvant chemotherapy for patients with seminoma. Looking at this QPI in more detail, it was noted that regions that performed better tended to have centralised treatment, supporting the argument for this model of care.…”