SU29.1-11 | Urinary System Surgery — Glossary

A drug such as finasteride that reduces conversion of testosterone to dihydrotestosterone, shrinking a large prostate over months.

Infection of the kidney and renal pelvis (upper UTI) with fever, rigors and loin pain; systemically unwell.

Sudden, painful inability to pass urine with a tender, palpable bladder; a surgical emergency relieved by immediate catheterisation.

A drug such as tamsulosin that relaxes prostatic and bladder-neck smooth muscle to relieve the symptoms of BPH.

The classic dismembered pyeloplasty for PUJ obstruction — the narrow segment is excised and a funnelled renal pelvis is re-anastomosed to the ureter.

Treatment that lowers or blocks androgen action (LHRH agonists/antagonists, anti-androgens) for locally advanced or metastatic prostate cancer.

A benign renal tumour of fat, smooth muscle and vessels, sometimes associated with tuberous sclerosis.

Renal pelvic dilatation detected on the routine antenatal ultrasound; the commonest way congenital GU anomalies first come to attention, most often due to PUJ obstruction.

The penile (pendulous) and bulbar segments of the male urethra, enclosed within the corpus spongiosum; the site of most strictures.

Industrial chemicals (aniline dyes, rubber, printing) that are established occupational risk factors for urothelial (bladder) cancer.

Significant bacteriuria on culture with no urinary symptoms; treated only in pregnancy or before urological instrumentation.

Non-malignant enlargement of the prostate arising in the transition (periurethral) zone, causing outflow obstruction and LUTS.

Inner-cheek mucosal graft used in substitution urethroplasty; favoured for its wet, elastic, robust epithelium and low donor-site morbidity.

The part of the anterior urethra within the bulb of the penis; the single commonest site of urethral stricture, typically after straddle trauma.

The commonest renal stone (~70-80%); radiopaque on plain X-ray.

Multiple rounded pulmonary metastatic deposits classically seen with renal cell carcinoma (and some other tumours).

Adenocarcinoma arising in the peripheral zone of the prostate; felt as a hard, nodular gland on DRE and metastasising chiefly to bone.

Urinary infection related to an indwelling catheter; managed by removing or changing the catheter alongside antibiotics for true infection (not mere colonisation).

Abnormal ventral curvature of the penis, characteristically associated with hypospadias and corrected at the time of urethroplasty.

Painless accumulation of a large residual urine volume; may be high-pressure (with hydronephrosis and renal impairment) or low-pressure (kidneys preserved).

Haematuria, flank (loin) pain and a palpable abdominal mass — an UNCOMMON presentation of RCC that indicates late, advanced disease.

The most common histological subtype of renal cell carcinoma, named for its lipid-rich clear cytoplasm.

UTI with an abnormal tract or vulnerable host — obstruction, stone, catheter, immunosuppression, pregnancy, male sex or diabetes — requiring a search for the underlying cause.

A structural birth defect of the urinary tract or genital organs, often detected antenatally and capable of impairing renal or reproductive function if untreated.

The vascular erectile tissue surrounding the anterior urethra; its scarring (spongiofibrosis) is what makes an anterior stricture rigid.

Contrast CT of the urinary tract; the imaging investigation of choice for the upper tract, showing renal masses, stones and upper-tract urothelial tumours.

A rare, inherited stone occurring in cystinuria.

Infection/inflammation of the bladder, the typical lower UTI, presenting with dysuria, frequency, urgency and suprapubic pain.

Intermittent severe loin pain (often after a large fluid load) caused by intermittent PUJ obstruction, a classic late presentation in older children.

Palpation of the prostate through the anterior rectal wall to assess its size, surface, consistency, symmetry, median sulcus, nodules and tenderness.

Endoscopic incision of the stricture under direct vision (optical internal urethrotomy); best for short (<1-2 cm) single bulbar strictures, recurrence common.

A functional nuclear scan that confirms true obstruction and measures split renal function in a dilated system.

A static radionuclide cortical scan that assesses differential renal function and demonstrates cortical scarring from reflux nephropathy.

A kidney drained by two ureters; the upper-pole ureter tends to obstruct and the lower-pole ureter tends to reflux.

Distorted red cells produced as they are squeezed through a diseased glomerular filtration barrier; a marker of glomerular bleeding.

Pain or burning on passing urine, a cardinal symptom of lower urinary tract infection.

A fulminant gas-forming necrotising infection of the kidney occurring almost exclusively in diabetics; needs resuscitation and drainage, sometimes nephrectomy.

Extracorporeal shock-wave lithotripsy — non-invasive fragmentation of suitable smaller stones using focused shock waves.

Urethroplasty in which the scarred segment is excised and the healthy ends joined directly; the procedure of choice for short bulbar strictures.

A spectrum of midline closure failure of the lower abdominal and bladder wall with a dorsally placed urethral defect, requiring staged reconstructive surgery.

Endoscopic inspection of the bladder and lower tract; the gold-standard test for bladder lesions in haematuria evaluation.

Necrotising fasciitis of the perineum, scrotum and genitalia; a surgical emergency requiring immediate aggressive debridement plus broad-spectrum antibiotics.

Histological grading of prostate adenocarcinoma aggressiveness assigned on biopsy.

The presence of red blood cells in the urine, classified by visibility, by timing within the stream, and by anatomical source.

Congenital fusion of the lower poles of both kidneys across the midline, tethered under the inferior mesenteric artery and prone to stasis, stones and PUJ obstruction.

Dilatation of the renal pelvis and calyces; the common radiological signature of urinary obstruction or high-grade reflux, indicating where to look rather than the specific cause.

Congenital anomaly with a ventral ectopic urethral meatus, ventral chordee and a dorsally hooded prepuce; repaired by urethroplasty and never managed by circumcision.

Stricture caused by medical instrumentation — traumatic catheterisation, endoscopy, TURP or a prolonged indwelling catheter; a leading modern cause.

Blood at the start of voiding that clears as the stream continues; localises the source to the urethra or prostate.

Bacillus Calmette-Guerin instilled into the bladder as immunotherapy to reduce recurrence and progression of high-risk NMIBC.

A validated questionnaire that quantifies the severity of lower urinary tract symptoms in benign prostatic hyperplasia.

An internal ureteric stent placed retrogradely to relieve ureteric obstruction and drain the kidney.

A urine dipstick enzyme marker of white cells, supporting the presence of pyuria and infection.

Balanitis xerotica obliterans — a chronic sclerosing inflammatory condition causing meatal and anterior urethral scarring and stricture.

Voiding symptoms (hesitancy, poor stream, terminal dribbling, incomplete emptying) and storage symptoms (frequency, urgency, nocturia) arising from outflow obstruction or bladder dysfunction.

A dynamic radionuclide study that distinguishes a truly obstructed system from a merely dilated one by tracking tracer washout after a diuretic.

The midline groove between the prostatic lobes felt on DRE; preserved in benign enlargement and lost in carcinoma.

Bleeding from the glomerulus giving dysmorphic red cells, red-cell casts and proteinuria; referred to nephrology.

Use of an alpha-blocker such as tamsulosin to aid spontaneous passage of a small ureteric stone.

The short posterior-urethral segment piercing the urogenital diaphragm; the narrowest, least mobile part, torn/distracted in pelvic fractures.

Muscle-invasive bladder cancer, invading the detrusor muscle; managed by radical cystectomy with urinary diversion or radical radiotherapy.

Voiding study after bladder filling that displays the posterior urethra above a stricture; combined with RGU to map the whole urethra.

Contrast study of the bladder and urethra during voiding; diagnostic for posterior urethral valves and used to grade vesicoureteric reflux (I–V).

MRI of the prostate that characterises suspicious lesions and guides targeted biopsy when carcinoma is suspected.

Non-contrast CT of kidneys, ureters and bladder; the gold-standard investigation for urinary stones, detecting size, site and radiolucent stones.

A dipstick marker of infection produced when Enterobacteriaceae such as E. coli reduce urinary nitrate to nitrite.

Non-muscle-invasive bladder cancer, confined to mucosa/submucosa; managed by TURBT plus intravesical therapy with surveillance.

Red cells detected only on dipstick and microscopy, with urine that looks normal to the patient.

Reduced amniotic fluid volume; in PUV it reflects impaired fetal urine output and, when severe, risks pulmonary hypoplasia.

A benign renal tumour that can mimic RCC on imaging.

Surgical placement and fixation of an undescended testis into the scrotum, ideally performed by about 6–12 months of age.

Sclerotic (bone-forming) secondary deposits characteristic of metastatic prostate carcinoma; bone is its commonest site of distant spread.

Visible blood in the urine without pain — the hallmark presenting feature of bladder cancer, which must be investigated even if intermittent.

Systemic effects of a tumour not due to local spread; in RCC includes polycythaemia, hypercalcaemia, hypertension and Stauffer's syndrome.

Excision of a small renal tumour (typically T1) while preserving functioning kidney, the preferred approach for small tumours.

Percutaneous nephrolithotomy — keyhole renal access to remove large, lower-pole or staghorn stones (generally >2 cm).

Distraction or rupture of the membranous (posterior) urethra accompanying a pelvic fracture, healing as a dense scar or distraction defect.

The junction of the renal pelvis and ureter; the commonest congenital site of obstruction and a frequent site of stone impaction.

Impaired drainage at the junction of the renal pelvis and ureter; the commonest cause of antenatal hydronephrosis, treated when truly obstructive by pyeloplasty.

A tube placed through the skin into the renal pelvis to decompress an obstructed (especially infected) kidney.

Image-guided placement of a drainage tube into the renal collecting system through the flank, used to urgently decompress an obstructed infected kidney.

A collection of pus around the kidney, within the perinephric tissues, that must be drained.

The outer, posterior zone of the prostate nearest the rectum; the site of origin of most prostate adenocarcinomas and the part felt on digital rectal examination.

A localised collection of pus around the urethra complicating a stricture, which may discharge to form sinuses or a urethral fistula.

A brisk loss of water and electrolytes after relieving chronic retention; requires monitoring and replacement of fluids and electrolytes. Also called post-decompression diuresis.

The urine left in the bladder after voiding, measured by ultrasound; raised in obstruction and a measure of the obstructive burden.

The membranous and prostatic segments of the male urethra; the membranous part is distracted in pelvic-fracture urethral injury.

Obstructing membranous folds in the posterior (prostatic) urethra of MALE infants; the commonest cause of lower urinary tract obstruction in male newborns.

A serum marker produced by prostatic epithelium; organ-specific but not cancer-specific, rising in BPH, prostatitis and carcinoma.

Red or dark urine without red cells on microscopy, e.g. from beetroot, rifampicin, myoglobinuria or haemoglobinuria.

Obstruction at the pelviureteric junction, the commonest congenital cause of unilateral hydronephrosis.

Surgical reconstruction of the pelviureteric junction to relieve PUJ obstruction causing hydronephrosis.

An infected, obstructed kidney (pus behind a blockage); a urological emergency requiring urgent decompression, not antibiotics alone.

The presence of white cells (pus) in the urine, seen on microscopy and indicating urinary tract inflammation/infection.

Removal of the bladder (with pelvic lymph node dissection and urinary diversion), the standard surgical treatment for muscle-invasive bladder cancer.

Removal of the kidney with its surrounding (Gerota's) fascia, the standard operation for a large or locally advanced renal cell carcinoma.

A cylindrical mould of red cells and protein formed in the renal tubule; the fingerprint of glomerular (medical) haematuria.

Renal cortical scarring resulting from reflux of infected, high-pressure urine to the kidney, leading over time to hypertension and chronic kidney disease.

A stone within the urinary tract, classified by chemical composition; a leading cause of urinary obstruction.

The commonest adult malignant renal tumour, arising from proximal tubular epithelium; the clear-cell subtype is most common.

The commonest renal-parenchymal malignancy; may present with haematuria, flank pain or a mass, and is treated by partial or radical nephrectomy.

Contrast injected per meatum to outline the anterior urethra and define the site, length and number of strictures; the key imaging study.

Chronic infection with Schistosoma haematobium that predisposes to squamous cell carcinoma of the bladder in endemic regions.

Chronic urinary fluke infection that causes haematuria and predisposes to squamous-cell carcinoma of the bladder.

A urine culture colony count of ≥10⁵ CFU/mL of a single organism in a clean-catch midstream specimen (lower counts may count in symptomatic or catheter samples).

Each kidney's individual contribution to total function, measured on renography to decide whether an obstructed kidney is worth salvaging.

Fibrous scarring of the urethral epithelium and the surrounding corpus spongiosum; the pathological substrate of anterior urethral stricture, determining its severity and treatment.

Deformation of the urinary stream into a spray or split jet by a strictured segment — a characteristic symptom of urethral stricture.

A bladder cancer associated with chronic inflammation and schistosomiasis, distinct from the common transitional cell carcinoma.

A large branched stone filling the renal pelvis and calyces, classically struvite, associated with chronic urease-producing infection.

A reversible, non-metastatic hepatic dysfunction associated with renal cell carcinoma, resolving after nephrectomy.

A blunt perineal injury (e.g. falling astride a bar) that crushes the bulbar urethra against the inferior pubis — the classic cause of bulbar stricture.

A magnesium ammonium phosphate stone forming in alkaline, infected urine (typically Proteus); can grow into a branched staghorn calculus.

Magnesium ammonium phosphate stone forming in alkaline urine with urease-producing organisms (e.g. Proteus); the typical infection/staghorn stone.

Urethroplasty that augments or replaces the lumen with a graft or flap (commonly buccal mucosa) for longer strictures where the ends cannot be joined.

A catheter placed directly into the bladder through the lower abdominal wall; the safe drainage route in acute retention when the urethra cannot be passed.

Bleeding from the drainage tract giving isomorphic red cells, often clots and no casts; worked up by imaging and cystoscopy.

Blood at the end of voiding; localises the source to the bladder neck, trigone or posterior urethra.

Blood throughout the urinary stream, often with clots; implies bleeding from the bladder or the upper tract (kidney/ureter).

The periurethral zone of the prostate surrounding the urethra; the site of origin of benign prostatic hyperplasia.

Urothelial carcinoma; the commonest type of bladder cancer and also the cancer of the renal pelvis and ureter.

Cancer of the urothelium lining the renal pelvis, ureter, bladder and proximal urethra; the commonest cause of painless visible haematuria.

Direct tumour extension into a vein; RCC characteristically extends along the renal vein into the inferior vena cava.

Transurethral resection of bladder tumour; the initial diagnostic and therapeutic procedure for bladder transitional-cell carcinoma.

The gold-standard operation for benign prostatic hyperplasia, resecting obstructing prostatic tissue through the urethra.

First-line, radiation-free imaging for hydronephrosis; shows pelvicalyceal dilatation and is preferred in children and pregnancy.

Infection in a healthy non-pregnant adult with a structurally and functionally normal urinary tract.

Failure of a testis to descend into the scrotum, leaving it in the abdomen or inguinal canal; treated by orchidopexy to reduce infertility and malignancy risk.

A bacterial enzyme (notably from Proteus) that splits urea to ammonia, alkalinising the urine and predisposing to struvite stones.

Severe, colicky loin-to-groin pain from a stone moving down the ureter; the patient is characteristically restless.

Surgical re-creation of a competent ureterovesical flap valve, reserved for high-grade or refractory vesicoureteric reflux.

A tube placed retrogradely up the ureter to relieve obstruction and restore urine drainage from the kidney to the bladder.

Endoscopic access to the ureter, usually with laser lithotripsy, well suited to ureteric stones.

Passage of a catheter through the urethra to drain the bladder; the first-line means of relieving acute retention.

Stretching/splitting the strictured scar with bougies or balloons; a simple temporising measure with high recurrence, not a definitive cure.

Fibrous narrowing of the urethral lumen caused by scarring (spongiofibrosis), producing a rigid, non-distensible segment and obstructed voiding.

Reconstructive repair of hypospadias that relocates the meatus to the tip, corrects chordee and rebuilds the urethra, typically performed at ~6–18 months.

A radiolucent stone forming in acidic urine; invisible on plain X-ray and dissolvable by alkalinising the urine.

Reconstruction to drain urine after cystectomy, most commonly an ileal conduit.

Infection of any part of the urinary tract; classified as lower (cystitis/urethritis) or upper (pyelonephritis), and as uncomplicated or complicated.

Microscopic examination of urine for malignant cells; sensitive for high-grade urothelial cancer but insensitive for low-grade tumours, so a negative result does not exclude cancer.

Non-invasive measurement of urinary flow rate; a stricture gives a low, prolonged, plateau (flat-topped/box-shaped) curve rather than the normal bell shape.

Sepsis arising from a urinary tract source — tachycardia, hypotension, confusion and low urine output — a medical emergency often layered on a surgical cause.

The transitional epithelium lining the urinary tract from renal pelvis to bladder; its 'field-change' behaviour explains multifocal, recurrent tumours.

Dilatation of the pampiniform plexus; a left-sided non-emptying varicocele suggests left renal vein/IVC obstruction by tumour.

Where the ureter enters the bladder; the narrowest point of the ureter and a common site of stone impaction.

Retrograde flow of urine from the bladder up the ureter due to a failed ureterovesical flap valve; graded I–V and a cause of recurrent UTI and reflux nephropathy.

Urine discoloured red or smoky that the patient can see; in adults, painless visible haematuria is urological malignancy until proven otherwise.

The commonest renal tumour of childhood (usually under age 5), an embryonal tumour treated by nephrectomy plus chemotherapy with good prognosis.