Surgical Procedures

Adrenalectomy — open, laparoscopic, or robotic — is the surgical treatment for functioning and malignant adrenal tumours. This page covers preoperative preparation, surgical anatomy, operative approaches, tumour-speci…

Radical cystectomy with bilateral pelvic lymphadenectomy is the standard surgical treatment for muscle-invasive and BCG-unresponsive high-risk non-muscle-invasive bladder cancer. It removes the bladder together with t…

TURBT is both the diagnostic and the first-line therapeutic procedure for bladder cancer. The technical quality of TURBT is the single most important determinant of accurate staging and of recurrence risk in non-muscl…

Endopyelotomy and endoureterotomy treat obstruction by incising the narrowed segment full-thickness — from normal calibre proximally, through the stricture, into normal calibre distally — and then stenting the cut so…

Percutaneous nephrolithotomy is the standard of care for large and complex renal stones. A tract is dilated into the collecting system, and stones are fragmented and extracted under direct nephroscopic vision. It offe…

Shock wave lithotripsy is the only non-invasive stone treatment: focused shock waves fragment the stone, and the fragments pass spontaneously. It is best for smaller, lower-density stones in favourable anatomy, and it…

Ureteroscopy with laser lithotripsy is the workhorse of modern stone surgery. Modern flexible ureteroscopes and high-power lasers give access to the entire upper urinary tract and can reliably fragment any stone compo…

Radical nephroureterectomy (RNU) with complete bladder cuff excision is the standard of care for high-risk upper tract urothelial carcinoma (UTUC). Its oncologic principles are en-bloc removal of the entire ipsilatera…

Partial nephrectomy (nephron-sparing surgery) removes a renal tumour while preserving the rest of the kidney, and is the treatment of choice for most localized renal masses — oncologically equivalent to radical nephre…

Radical nephrectomy is the standard operation for renal masses not amenable to nephron-sparing surgery. The principle is en bloc removal of the kidney with its surrounding perinephric fat inside Gerota's fascia, with…

Operative repair of renal trauma has become uncommon: accurate CT staging and the success of non-operative management mean most renal injuries — even deep lacerations and many penetrating injuries — are managed withou…

Thermal ablation destroys a renal tumour in situ with cold or heat and is a nephron-sparing option for small renal masses in older or comorbid patients, those with hereditary multifocal disease, or an imperative indic…

Circumcision — surgical removal of the prepuce — is among the most common urologic operations, performed for religious, social, and medical reasons. Medical indications include phimosis (inability to retract the fores…

Genital injuries are rare but can devastate sexual, reproductive, and psychological health. They are seldom life-threatening, so stabilise other major injuries first. The goals of repair are to minimise further injury…

Inguinal lymphadenectomy is the therapeutic nodal operation for penile squamous cell carcinoma — it can be curative when disease is limited to the inguinal nodes. Indications and nodal staging logic (DSNB, when to ope…

Surgery for penile squamous cell carcinoma spans a spectrum from organ-sparing ablation through partial and total penectomy, chosen by tumour stage, grade, size, and location. The twin goals are oncological control an…

Penile fracture — disruption of the tunica albuginea with rupture of the corpus cavernosum — is a urologic emergency best managed by prompt surgical exploration and repair, which lowers the rates of erectile dysfuncti…

Penile prosthesis implantation is the definitive, third-line surgical treatment for erectile dysfunction that has failed oral PDE5 inhibitors, intracavernosal injection, and the vacuum erection device (VED). Two devic…

Peyronie disease causes fibrous plaque of the tunica albuginea with penile curvature and deformity (hourglass or hinge effect). The modern approach has shifted away from cutting the tunica: since collagenase Clostridi…

Priapism is a persistent penile erection (> 4 hours) unrelated to sexual stimulation. The first and most important step is distinguishing ischemic (low-flow, veno-occlusive) priapism — a painful, compartment-syndrome…

Vasectomy is the most common urologic procedure for permanent male contraception — safe, office-based under local anesthesia, and highly effective. The core of good practice is thorough counseling about permanence and…

Vasectomy reversal is a microsurgical reconstruction that restores continuity of the excurrent duct — either vasovasostomy (VV), a vas-to-vas anastomosis, or vasoepididymostomy (VE), a vas-to-epididymis anastomosis wh…

Endoscopic surgery is the mainstay of operative management for bladder outlet obstruction due to benign prostatic enlargement. The options range from resective and ablative techniques (TURP, photovaporization) to mini…

Open simple prostatectomy removes the hyperplastic transition-zone adenoma while leaving the surgical capsule (peripheral zone) behind — the open counterpart of transurethral enucleation, reserved for large and very l…

Beyond surgery and external-beam radiation, localized prostate cancer can be treated by energy ablation (whole-gland or focal) and by brachytherapy (implanted radioactive seeds). Ablation destroys tumour with cold, he…

Prostate biopsy confirms prostate cancer when clinically significant disease is suspected and the result will change management. It is performed transrectally or transperineally under ultrasound guidance, and modern p…

Radical prostatectomy removes the entire prostate and seminal vesicles with a vesicourethral anastomosis, and is a curative option for localized prostate cancer. It can be performed open (retropubic or perineal), lapa…

Pyeloplasty reconstructs the ureteropelvic junction (UPJ) to relieve obstruction of urine flow from the renal pelvis into the proximal ureter. The dismembered (Anderson-Hynes) repair is the gold standard, with a > 90%…

Segmental ureterectomy is a kidney-sparing extirpative option for selected upper tract urothelial carcinoma, removing the diseased ureteral segment with reconstruction of urinary continuity. It is a reasonable alterna…

These are the operative techniques for repairing a ureteral defect or stricture, chosen by the length and location of the defect. The clinical indications, defect-length comparison, and contraindications are covered i…

Urethral reconstruction restores unobstructed micturition — ideally from a glanular meatus with good cosmesis — along the length of the urethra. The disease differs by segment: an anterior urethral stricture is a scar…

Urinary diversion re-routes the upper urinary tract after cystectomy (or for a diseased/dysfunctional bladder) using a reconfigured segment of bowel. Options fall into three families: conduit (incontinent cutaneous),…

A vesicovaginal fistula (VVF) is an abnormal communication between the bladder and vagina that causes continuous urinary incontinence. It is the most common acquired urinary-tract fistula, and repair can be approached…

Orchiopexy surgically relocates an undescended (cryptorchid) testis into a dependent scrotal position and fixes it there. Surgery is considered if a testis has not descended by 6 months of age, and orchiopexy is usual…

Radical inguinal orchiectomy is usually the first step in managing a testicular germ-cell tumour: it removes the testicle and spermatic cord to the internal inguinal ring, yielding histologic diagnosis, staging inform…

Acute testicular torsion is one of the few true urologic surgical emergencies — delay leads to testicular loss and carries clear medicolegal weight. The operative goal is prompt scrotal exploration to detorse the cord…

Retroperitoneal lymph node dissection (RPLND) is a cornerstone of NSGCT management — for primary staging/treatment of clinical stage I or low-volume stage II disease, and for resection of a residual mass after chemoth…

Testicular tissue is sampled for two purposes: diagnostic biopsy (histology in azoospermia, tumour or intersex evaluation) and therapeutic sperm retrieval (harvesting sperm for IVF/ICSI in azoospermia or ejaculatory d…

Varicocelectomy ligates the refluxing internal spermatic (gonadal) veins so that warm, retrograde corporeal blood no longer reaches the testis, improving testicular function. The gonadal veins (running scrotum-to-retr…

The artificial urinary sphincter (AUS, AMS 800) is the gold-standard surgical treatment for moderate-to-severe male stress urinary incontinence, most often post-prostatectomy incontinence. The device has three connect…

Intravesical injection of onabotulinumtoxinA (Botox) into the detrusor is a treatment for overactive bladder / urge urinary incontinence and neurogenic detrusor overactivity refractory to behavioural therapy and medic…

Female stress urinary incontinence (SUI) — leakage with raised abdominal pressure — is treated surgically when conservative measures fail or are declined. The options run from least to more invasive: periurethral bulk…

Neuromodulation uses electrical stimuli to alter neurotransmission in refractory storage and emptying disorders. The mainstay is sacral neuromodulation (SNM) — the implanted InterStim system, placed in two stages or t…