TNRF2: Urology

Overview

Circumcision is the surgical removal of the foreskin. In men, circumcision is most commonly carried out when the foreskin is tight and won't pull back (retract), which is known as phimosis.

Thresholds and eligibility 

Male circumcision in Surrey in not routinely funded. 

Conservative measures should always be explored prior to referral for surgery. 

This policy covers men of all ages however it should be noted that for those under 16 consultations should focus on reassurance and education of parents and child. If there is concern that any pathology is evident, or if there is diagnostic uncertainty, referral to a regional centre undertaking paediatric surgery is indicated. The expectation is that this would be a minority of children. For information, the proportion of partially or fully retractable foreskin is only 4% at birth but increases to 99% by the age of 14. 

Male circumcision will be funded in Surrey for patients with:

• Recurrent paraphimosis where conservative treatment has failed (more than 3 clinically significant episodes annually).
• Malignant or pre-malignant preputial lesion that is confined to the foreskin.
• Recurrent balanitis where conservative treatment has failed (more than 3 clinically significant episodes annually).
• Congenital abnormalities of the urinary tract and in order to prevent urinary tract infection in patients with an abnormal urinary tract.
• Traumatic foreskin injury where it cannot be salvaged.
• Pain on arousal or interference with sexual function where conservative measures have been attempted and have failed, including topical steroids and education*
  • the expectation would be that this would normally be in over 16s.

Note: female circumcision is illegal.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

A varicocele is an enlargement of the veins in your scrotum. Varicocelectomy is a surgery performed to remove those enlarged veins. The procedure is carried out to restore proper blood flow to your reproductive organs.

Thresholds and eligibility 

Surgical removal of varicocele in adults and children may be funded where the patient meets the following criteria:

Children (under 16):

• Grade II or III varicocele

AND

• Asymmetrical greater than 2cm³

OR

• greater than a 20% difference

Adults:

• Grade II or III varicocele

AND

• Symptomatic with persistent pain/significant discomfort despite adequate conservative management

OR

• With abnormal semen parameters

Men should be informed that surgery for varicoceles as a form of fertility treatment is not advised because it may not improve pregnancy rates.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.