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The paper by Mr Allen and his colleagues (June 2004 JRSM1) is a useful contribution to the debate on the two-week cancer services and we agree with many of their conclusions. However, we take issue with the comments suggesting that general practitioners should be offered rapid access to scrotal ultrasonography. We have had a large number of inappropriate primary care referrals for scrotal ultrasound, the majority for uncomplicated epididymal cysts, hydroceles and post-vasectomy changes. We have therefore agreed the following criteria as indications for scrotal ultrasound examination:
We feel with the increasing burden on the ultrasound service it is more cost-effective for patients, where there is doubt of the diagnosis, to have a urological opinion. There is a need for more training in scrotal examination amongst primary care physicians. We appreciate that an ultrasound showing an innocent condition can be very reassuring for patients but the same reassurance can often be given by a general practitioner who is totally confident in the diagnosis or, if appropriate, by a consultant urologist.