Treatments
We Treat

Ureteroscopic stone lithotripsy using a flexible or semi-rigid ureteroscope passed through the urethra and ureter. A holmium laser fibre fragments the stone into dust or small passable pieces, which are then retrieved or allowed to pass naturally.

A flexible ureteroscope is advanced retrogradely into the renal collecting system. Holmium laser energy pulverises stones located within the kidney (renal pelvis and calyces) without any incision, making it ideal for stones up to 2 cm.

A 1 cm tract is created through the skin and flank directly into the kidney under fluoroscopic or ultrasound guidance. A nephroscope is inserted and the stone is fragmented and removed, making it the gold standard for large (>2 cm) or complex renal stones.

A miniaturised version of PCNL using smaller access sheaths (14–20 Fr for Mini; 11–13 Fr for Ultra-Mini). It reduces blood loss, post-operative pain, and hospital stay compared to standard PCNL while maintaining effective stone clearance.

A double-J ureteric stent (a soft, coiled tube) is placed endoscopically from the renal pelvis to the bladder to maintain ureteral patency, relieve obstruction, and facilitate post-operative drainage after stone procedures.

An open surgical incision is made in the flank or abdomen to directly access the ureter, which is opened (ureterotomy) and the stone is extracted. Reserved for very large, impacted ureteric stones inaccessible to endoscopic techniques.

A resectoscope is passed through the urethra and monopolar electrical current is used to resect (shave away) obstructing prostatic tissue in chips. It is the long-established gold standard surgical treatment for symptomatic BPH.

An evolution of standard TURP in which bipolar electrical energy is used in saline irrigation, eliminating the risk of TUR syndrome (hyponatraemia). It provides equivalent resection with improved safety, especially in patients with cardiac or metabolic comorbidities.

A holmium laser is used to enucleate the entire prostatic adenoma in anatomical lobes, which are then morcellated in the bladder and removed. It is size-independent, bloodless, and provides the most durable long-term results of any endoscopic BPH procedure.

GreenLight (KTP/XPS) laser vaporises prostatic tissue using photoselective energy with minimal bleeding, suitable for anticoagulated patients. ThuLEP uses thulium laser for precise enucleation with excellent haemostasis and reduced catheterisation time.

A retropubic open surgical approach in which the prostatic adenoma is manually enucleated through a lower abdominal incision. Millin's procedure is used for very large glands (>100 mL) not amenable to endoscopic techniques, providing definitive tissue removal.

Transurethral resection using monopolar electrosurgery to remove obstructing prostatic tissue chip by chip through the urethra — the most widely performed surgical procedure for bladder outlet obstruction from prostatic enlargement.

Resection performed using bipolar electrical energy in saline, which eliminates TUR syndrome risk. Particularly preferred in elderly or cardiac patients requiring a safer electrolyte-neutral surgical environment.

Complete holmium laser enucleation of the prostatic lobes with intravesical morcellation. Offers size-independent treatment with low re-operation rates, making it the preferred approach for glands of any size in experienced hands.

High-powered 532 nm green laser selectively absorbed by haemoglobin vaporises prostatic tissue with simultaneous coagulation. Preferred for patients on anticoagulants or with anaesthetic risk, as it achieves haemostasis with very low transfusion rates.

Surgical enucleation of the adenoma through an open abdominal or perineal approach for very large glands. It provides excellent symptom relief and durable results, with longer hospital stay than endoscopic methods.

A drainage tube is inserted through the skin into the renal pelvis under ultrasound or fluoroscopic guidance to relieve upper urinary tract obstruction complicated by infection. It provides immediate decompression, preventing sepsis and preserving renal function.

An endoscopic double-J stent is placed across the obstructed ureter to restore internal urine drainage and relieve the obstructive cause of complicated UTI, while systemic antibiotics address the infective component.

Surgical reimplantation of the ureter into the bladder at a new anti-reflux position, performed when vesicoureteral reflux or ureteral obstruction is identified as the structural cause of recurrent complicated urinary tract infections.

Image-guided percutaneous aspiration or surgical drainage of a renal or perinephric abscess complicating severe upper UTI (pyelonephritis). Removes the infected collection, reduces systemic sepsis burden, and accelerates resolution with concurrent antibiotic therapy.

Endoscopic removal of obstructing prostatic tissue by transurethral resection (TURP) or holmium laser enucleation (HoLEP) in patients whose urinary retention is caused by benign prostatic enlargement, enabling definitive restoration of voiding.

Optical Internal Urethrotomy uses a cold knife or laser passed through a urethrotome to incise a urethral stricture under direct vision, relieving the obstruction responsible for urinary retention when a stricture is the underlying cause.

A catheter is inserted through a small suprapubic incision or percutaneously into the bladder dome to drain urine when urethral catheterisation is impossible, contraindicated, or inadequate as a long-term solution for chronic retention.

An endoscopic incision is made at the 5 and 7 o'clock positions of the bladder neck using a cold knife or electrocautery to relieve functional or anatomical bladder neck obstruction causing urinary retention, particularly in younger men.

A drainage tube inserted through the flank into the dilated renal pelvis under imaging guidance to decompress the obstructed kidney urgently, protect renal function, and allow definitive treatment of the underlying obstructive cause to be planned safely.

Internal ureteral stenting from the renal pelvis to the bladder via cystoscopy restores antegrade urine drainage, relieves hydronephrosis, and protects kidney function while the cause of obstruction is being investigated and treated.

Dismembered or non-dismembered reconstruction of the ureteropelvic junction (UPJ) to relieve obstruction causing hydronephrosis. Laparoscopic and robotic approaches (Anderson-Hynes) offer equivalent outcomes to open surgery with shorter recovery and smaller incisions.

Surgical removal of a kidney that has been irreversibly damaged by longstanding hydronephrosis and has no meaningful residual function. Performed laparoscopically or open, it removes a source of potential infection and pain while the contralateral kidney compensates.

A urethrotome is passed under direct vision and the stricture is incised with a cold knife or laser at the 12 o'clock position, widening the urethral lumen. Most effective for short (<1.5 cm) strictures at initial presentation; recurrence rates are higher for longer or recurrent strictures.

The scarred urethral segment is completely excised and the healthy urethral ends are spatulated and re-anastomosed. Gold standard for short bulbar urethral strictures up to 2–3 cm, with success rates exceeding 90% at long-term follow-up.

Buccal mucosa harvested from the inner cheek is used to augment or replace the diseased urethral segment (dorsal inlay, ventral onlay, or substitution urethroplasty). Preferred for longer, more complex, or penile strictures where excision and anastomosis is not feasible.

A two-stage reconstruction is used for severe, complex, or lichen sclerosus-related pan-urethral strictures. Stage 1 creates a urethral plate using buccal mucosa or skin graft; Stage 2 (6–12 months later) tubularises the plate to form a new urethra.

Surgical widening of the urethral meatus (meatal opening) by incision (meatotomy) or formal reconstruction (meatoplasty) for meatal or distal urethral strictures. A straightforward procedure that restores normal urinary stream and flow rate.

Sequential passage of bougie dilators or balloon catheters of increasing calibre through the urethra to stretch and disrupt the stricture. Provides temporary symptom relief but does not address the underlying scar tissue — recurrence is common without definitive repair.

A resectoscope is passed through the urethra and the bladder tumour is resected using monopolar or bipolar electrosurgery. Serves as both the diagnostic procedure (providing tumour stage and grade) and the primary treatment for non-muscle-invasive bladder cancer.

A second TURBT is performed 4–6 weeks after the initial resection for high-grade T1 tumours or whenever muscle is absent in the first specimen. Ensures complete resection, improves staging accuracy, and significantly reduces recurrence and upstaging rates.

Complete removal of the bladder, prostate and seminal vesicles (in men) or uterus and anterior vaginal wall (in women), with pelvic lymph node dissection. The definitive treatment for muscle-invasive bladder cancer is urinary diversion performed concurrently.

A 15–20 cm segment of ileum is isolated, the ureters are anastomosed to one end, and the other end is brought out as a permanent stoma (urostomy). The most reliable and widely performed form of urinary diversion after radical cystectomy.

A low-pressure reservoir is constructed from a detubularised ileal segment and anastomosed to the urethra, allowing continent voiding through the native urethra without a stoma. The Studer pouch is the most widely performed continent diversion technique worldwide.

Surgical excision of a localised bladder tumour with a 2 cm margin of normal bladder wall, preserving the remainder of the bladder. Reserved for selected solitary muscle-invasive tumours in locations amenable to complete excision with adequate remaining bladder capacity.

Robotic-assisted laparoscopic removal of the prostate and seminal vesicles using the da Vinci system. The magnified 3D view and wristed instrumentation enable precise nerve-sparing and urethrovesical anastomosis with less blood loss and faster continence recovery than open surgery.

Minimally invasive prostate removal using laparoscopic instruments through small port incisions. Offers reduced blood loss, shorter hospital stay, and equivalent oncological outcomes to open prostatectomy with the benefits of a minimally invasive approach.

Retropubic open removal of the entire prostate gland, seminal vesicles, and pelvic lymph nodes through a lower midline or Pfannenstiel incision. The historically established standard approach, offers direct tactile feedback and wide surgical access.

Surgical removal of both testes to permanently eliminate testicular testosterone production, providing immediate and lasting androgen deprivation for metastatic or castration-requiring prostate cancer. A simple, cost-effective alternative to long-term LHRH agonist injections.

Systematic removal of lymph nodes in the obturator fossa, internal and external iliac, and common iliac chains during radical prostatectomy. Provides accurate pathological nodal staging and may offer therapeutic benefit in node-positive disease through debulking.

Palliative transurethral resection of obstructing prostatic cancer tissue to relieve severe urinary obstruction in patients with advanced prostate cancer not amenable to curative treatment, restoring urinary flow and improving quality of life.

The entire kidney, perirenal fat, and Gerota's fascia are removed laparoscopically through small port incisions. Provides equivalent oncological control to open surgery for T1–T2 renal tumours with less blood loss, reduced analgesic requirement, and shorter hospitalisation.

The kidney is removed through a flank, loin, or transperitoneal incision along with the perirenal fat and the ipsilateral lymph nodes. Preferred for large (>10 cm), locally advanced, or venous thrombus-bearing tumours requiring wide surgical access and vascular control.

The testis is removed through an inguinal incision with ligation of the spermatic cord at the internal inguinal ring. This approach avoids disrupting lymphatic drainage and is the mandatory primary surgical treatment for any suspected testicular malignancy.

Template-based removal of retroperitoneal lymph nodes (the primary landing zone for testicular cancer metastases) along the great vessels. Performed for clinical stage II non-seminoma or post-chemotherapy residual masses, and provides accurate staging with potential therapeutic benefit.

Conservative excision of the tumour with intraoperative frozen section to confirm complete resection and benign or low-grade pathology, preserving the remaining testicular tissue. Appropriate for small (<2 cm), organ-confined tumours in a solitary testis or synchronous bilateral disease.

A polypropylene tape is placed beneath the mid-urethra through a retropubic (TVT) or transobturator (TOT) approach. It provides a hammock of support to the urethra during increased abdominal pressure, curing stress incontinence in over 85% of women.

Non-absorbable sutures elevate the bladder neck by suspending the paravaginal fascia to Cooper's ligament via an open retropubic or laparoscopic approach. A durable procedure with long-term cure rates of 70–85%, preferred when a mid-urethral sling is contraindicated.

A strip of the patient's own rectus fascia or fascia lata is harvested and placed beneath the bladder neck as a sling. Preferred for recurrent incontinence, urethral hypermobility, or intrinsic sphincter deficiency where synthetic mesh is avoided.

The AMS 800 device comprises a urethral cuff, pressure-regulating balloon reservoir, and scrotal control pump. It is the gold standard treatment for male stress urinary incontinence following radical prostatectomy, with social continence rates exceeding 85%.

When BPH-related bladder outlet obstruction is confirmed as the cause of nocturia through urodynamics and uroflowmetry, endoscopic prostatic tissue resection (TURP) or enucleation (HoLEP) relieves obstruction and significantly reduces nocturia episodes.

Transurethral Incision of the Prostate makes two endoscopic incisions at the 5 and 7 o'clock positions from the bladder neck to the verumontanum. It reduces outlet resistance in smaller glands (<30 mL) with lower retrograde ejaculation rates than TURP.

A detubularised segment of ileum (or sigmoid colon) is anastomosed to the opened bladder dome to increase total bladder capacity and reduce intravesical pressure. Used when nocturia is driven by a severely contracted, low-compliance bladder unresponsive to conservative management.

The hydrocele sac is opened through a scrotal incision, and the everted edges are sutured behind the testis (eversion technique), preventing fluid reaccumulation. The most widely performed hydrocelectomy technique has very low recurrence rates.

The hydrocele sac is plicated (gathered and sutured) without excision, reducing its size and preventing re-expansion. Preferred for smaller hydroceles as it involves less dissection, reducing the risk of haematoma and scrotal swelling in the post-operative period.

A laparoscopic approach through the inguinal canal to divide a patent processus vaginalis (communicating hydrocele), particularly in children and adolescents. Avoids a scrotal incision and allows simultaneous repair of any associated inguinal hernia.

The dilated testicular veins are approached through a small subinguinal incision and ligated under the operating microscope, with preservation of the testicular artery, lymphatics, and vas deferens. Gold standard approach with the lowest recurrence and complication rates.

The internal spermatic vein is approached laparoscopically at the level of the internal inguinal ring and clipped or ligated, allowing simultaneous bilateral repair through the same port sites. Suitable when bilateral varicoceles are present.

The spermatic vein is identified and ligated through an inguinal incision at the level of the inguinal ligament. The Ivanissevich technique is a reliable open approach, though microsurgical subinguinal repair offers lower recurrence and hydrocele formation rates.

The internal spermatic vein (and often artery en masse) is ligated through a retroperitoneal approach above the internal inguinal ring, where the vein is a single large trunk. Offers reliable ligation but carries a higher hydrocele formation rate than microsurgical approaches.

Complete surgical removal of the foreskin, providing a definitive cure for pathological phimosis (including lichen sclerosus), recurrent balanitis, and prevention of paraphimosis recurrence. The most effective and permanent surgical solution for foreskin pathology.

A longitudinal incision is made in the dorsal foreskin and closed transversely, widening the preputial ring while preserving the foreskin. A foreskin-sparing alternative to circumcision for men with phimosis who wish to retain the prepuce.

An urgent longitudinal incision is made along the dorsum of the retracted, oedematous foreskin to release the constricting band, relieve the paraphimosis, and restore blood supply to the glans. A time-critical procedure to prevent glans ischaemia and necrosis.

A Y-shaped incision is converted to a V-closure at the tight preputial ring to enlarge the preputial opening and relieve phimosis. It is a foreskin-preserving technique used when the phimosis is isolated to the tip of the foreskin without diffuse scarring.

The foreskin is excised using a sleeve resection or dorsal slit and trimming technique with fine absorbable sutures under local or general anaesthesia. Provides precise control of the amount of foreskin removed with excellent cosmetic outcomes.

A disposable circular stapling device is applied over the foreskin; simultaneous cutting and stapling of the preputial edge circumferentially removes the foreskin in one step. Faster than conventional surgery, with reduced intraoperative bleeding.

A CO2 or diode laser is used to excise the foreskin with simultaneous haemostasis of small vessels. Reduces bleeding and post-operative swelling compared to the conventional scalpel technique, with rapid wound healing.

Complete surgical removal of the foreskin, providing a definitive cure for pathological phimosis (including lichen sclerosus), recurrent balanitis, and prevention of paraphimosis recurrence. The most effective and permanent surgical solution for foreskin pathology.

Surgical exploration of the scrotum to confirm the diagnosis, drain any epididymal or testicular abscess, and assess testicular viability. Performed when scrotal ultrasound identifies an abscess collection that has failed to resolve with intravenous antibiotics alone.

Surgical removal of the epididymis through a scrotal incision, preserving the testis. Performed for chronic epididymitis with intractable orchalgia (scrotal pain), recurrent epididymal abscess formation, or an epididymal mass not responding to conservative management.

The scrotum is surgically opened on an emergency basis, the spermatic cord is untwisted, and testicular viability is assessed. If viable, the testis is fixed with permanent sutures (orchidopexy) and the contralateral testis is simultaneously fixed to prevent future torsion on either side.

If the torsed testis is found to be frankly non-viable (black, non-bleeding) after adequate detorsion, it is removed to prevent autoimmune antibody production that could compromise spermatogenesis in the contralateral healthy testis.

The undescended testis is mobilised through an inguinal incision, the spermatic cord is carefully freed to achieve adequate length, and the testis is placed in a sub-dartos scrotal pouch and fixed. The standard approach for palpable inguinal undescended testis.

A laparoscope is used to locate and bring down an intra-abdominal testis. The spermatic vessels are mobilised laparoscopically to achieve sufficient length, and the testis is transferred to the scrotum — either in a single stage or using the Fowler-Stephens technique.

For high intra-abdominal testes with short spermatic vessels, Stage 1 clips the main testicular artery laparoscopically to allow collateral blood supply to develop over 6 months. Stage 2 then mobilises and repositions the testis to the scrotum with adequate vascular perfusion.

For a truly ectopic or low-lying testis that can be reached through a high scrotal incision, the testis is directly accessed and fixed into a sub-dartos pouch without an inguinal incision, offering a simpler single-incision approach with faster recovery.

When untreated or recurrent urethritis leads to urethral scarring and stricture formation, optical internal urethrotomy incises the scar endoscopically under direct vision to restore urethral patency and improve urine flow.

Buccal mucosa graft urethroplasty is performed when urethritis-related stricture disease is extensive, recurrent, or involves a long segment of the urethra not suitable for simple urethrotomy or excision and anastomosis repair.

Excision and primary anastomosis urethroplasty removes the strictured segment and rejoins the healthy urethral ends — used for shorter, discrete fibrous strictures resulting from urethritis when endoscopic management has failed or is inappropriate.

The bladder is distended with fluid under general anaesthesia at cystoscopy, stretching the bladder wall and disrupting C-fibre pain pathways. Provides diagnostic information (Hunner's lesions, glomerulations) and therapeutic symptom relief lasting weeks to months.

A detubularised segment of ileum is sutured to the opened bladder, increasing total bladder capacity and reducing intravesical pressure. Used for severe, refractory IC/PBS where the bladder is contracted, causing intractable pain and frequency despite all other treatments.

In the most severe, refractory cases of interstitial cystitis, an ileal conduit urinary diversion is created (with or without cystectomy) as a last resort to eliminate the diseased bladder from the urinary stream and provide lasting relief from intractable bladder pain.

An intestinal segment (usually the ileum) is detubularised and incorporated into the opened bladder to create a large, low-pressure reservoir. This protects the upper tracts from high-pressure detrusor contractions and increases bladder capacity in neurogenic overactivity.

The appendix (or a tapered ileal segment) is used to create a continent catheterisable channel from the bladder to the umbilicus or lower abdomen. Patients perform clean intermittent catheterisation through this stoma — ideal for those unable to catheterise urethrally.

For severe neurogenic bladder with irreversible dysfunction, an incontinent ileal conduit diverts urine away from the dysfunctional bladder entirely. Eliminates the risk of high-pressure bladder damage to the upper tracts and simplifies urinary management.

A programmable neuromodulation device delivers continuous low-amplitude electrical stimulation to the S3 sacral nerve root via a percutaneous lead, modulating afferent and efferent bladder and sphincter neural pathways to treat refractory urgency incontinence and urinary retention.

A bladder neck sling (autologous fascial or synthetic) is placed to increase urethral outlet resistance in patients with neurogenic sphincter deficiency and stress urinary incontinence, improving continence between catheterisations.

The anterior vaginal wall is opened, the bladder is repositioned, and the pubocervical fascia is plicated with sutures to reinforce the anterior compartment support and correct the cystocele. A standard vaginal reconstructive procedure for bladder prolapse.

Reattachment of the detached lateral paravaginal fascia to the arcus tendineus fasciae pelvis (white line), correcting the lateral defect that allows the bladder to prolapse into the vagina. Performed vaginally, laparoscopically, or open retropubically.

A mesh is sutured to the anterior and posterior vaginal wall and fixed to the anterior longitudinal ligament of the sacrum laparoscopically. Provides durable apical and anterior vaginal support, with low prolapse recurrence rates and minimal vaginal scarring.

Robot-assisted laparoscopic sacrocolpopexy using the da Vinci system. The enhanced dexterity, tremor elimination, and magnified 3D view facilitate precise mesh suturing to the sacrum and vaginal wall with reduced surgeon fatigue in complex cases.

Combined anterior (cystocele repair) and posterior (rectocele/enterocele repair) vaginal wall plication performed in the same operation to address multi-compartment pelvic floor prolapse through a single vaginal approach.

Gold standard apical prolapse repair. A Y-shaped mesh bridges the anterior and posterior vaginal walls to the sacral promontory, correcting uterovaginal or vault prolapse. Laparoscopic approach offers equivalent outcomes with faster recovery than open surgery.

Robot-assisted sacrocolpopexy provides superior ergonomics, 3D visualisation, and precise mesh placement for complex multi-compartment prolapse. Facilitates meticulous dissection around the rectum, vagina, and sacral promontory.

Mesh suspension of the uterus to the sacral promontory to correct uterovaginal prolapse while preserving the uterus for women who desire uterine conservation. Performed laparoscopically or robotically with outcomes comparable to hysterectomy-based repair.

A vaginal obliterative procedure for elderly women with severe prolapse who are no longer sexually active. Strips of anterior and posterior vaginal epithelium are excised and the walls are sutured together, effectively closing the vaginal canal with very low recurrence.

The vaginal vault is sutured to the sacrospinous ligament (usually right-sided) through a transvaginal approach to suspend the prolapsed vault. A durable, widely used vaginal procedure for apical compartment prolapse that avoids laparotomy.

Through a lower abdominal incision, the ureter is detached and reimplanted into the bladder at a new position with a longer submucosal tunnel, creating an anti-reflux mechanism. Cohen's (cross-trigonal) and Politano-Leadbetter (suprahilar) are the two standard open techniques with >95% success rates.

An extravesical laparoscopic approach creates a longer submucosal tunnel for the ureter outside the bladder without opening the bladder lumen. Suitable for unilateral high-grade VUR with lower urinary retention rates than intravesical reimplantation.

Robotic-assisted extravesical or intravesical ureteric reimplantation using da Vinci instrumentation, providing superior precision in tunnel creation and anastomosis within the confined pelvic space, particularly in complex or redo cases.

Dextranomer/hyaluronic acid (Deflux) is injected submucosally beneath the ureteric orifice cystoscopically, bulking the orifice and creating a functional anti-reflux valve. A minimally invasive day-care procedure with 75–85% success for grade I–III VUR.

The obstructed ureteropelvic junction is excised, and the spatulated ureter is anastomosed to a dependent point of the trimmed renal pelvis laparoscopically. Gold standard treatment with >95% success, applicable to all UPJ obstructions, including those with crossing lower pole vessels.

Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. The articulating instruments and 3D vision facilitate precise intracorporeal suturing of the pelviureteric anastomosis, especially in technically challenging or redo cases.

Open flank or dorsal lumbotomy approach to perform dismembered or non-dismembered pelviureteric reconstruction. Preferred when laparoscopic skills are not available or in complex re-do UPJ repairs requiring wide surgical access.

A full-thickness incision of the UPJ is made endoscopically using an electrosurgical cutting wire (Acucise) or laser passed retrogradely or anterogradely. A less invasive alternative with moderate success rates (75–85%), reserved for intrinsic short-segment obstruction without crossing vessels.

Ureteric stenting across the UPJ provides temporary internal drainage of the obstructed renal pelvis while definitive pyeloplasty is planned, or post-operatively after pyeloplasty to protect the anastomosis during the healing period.

A double-J ureteric stent is inserted cystoscopically to bypass the obstruction and restore internal urine drainage from the kidney to the bladder. Provides immediate decompression while the underlying obstructive cause is investigated and definitively treated.

Antegrade drainage of an obstructed kidney via a tube inserted through the skin and flank under imaging guidance is used when retrograde stenting fails or is not feasible. Provides emergency upper urinary tract decompression.

Surgical reconstruction of a narrowed or damaged ureteral segment, or reimplantation of the ureter into the bladder using a psoas hitch or Boari flap for distal ureteral injuries or strictures, restoring normal anatomical continuity and drainage.

Laparoscopic division and re-anastomosis of the ureter over the obstructed segment, used for mid-ureteral strictures, crossing vessels, or iatrogenic injuries not amenable to endoscopic treatment, with the benefits of a minimally invasive approach.

Open surgical resection of the obstructed ureteral segment with spatulated end-to-end anastomosis is used for complex, lengthy, or redo ureteral reconstructions requiring wide surgical access and meticulous tissue handling.

A small paediatric cystoscope is passed through the urethra, and the obstructing valve leaflets are incised or fulgurated using electrocautery or laser under direct vision. The definitive primary treatment for PUV in neonates and infants is once the urethra is of sufficient calibre.

A temporary stoma is created by bringing the bladder dome to the skin surface (cutaneous vesicostomy) to provide continuous unobstructed urine drainage in neonates too small for urethral instrumentation, or when bladder compliance is severely impaired.

In cases of severe upper tract dilatation unresponsive to vesicostomy, one or both ureters are brought to the skin as cutaneous ureterostomies to provide the highest possible drainage and maximise renal salvage. A temporising measure before definitive reconstruction.

Endoscopic resection of urothelial tumours of the bladder using a monopolar or bipolar resectoscope. Simultaneously diagnoses (provides tumour grade and stage) and treats non-muscle-invasive urothelial carcinoma, forming the cornerstone of bladder TCC management.

Complete removal of the bladder and pelvic lymph nodes for muscle-invasive or high-risk non-muscle-invasive urothelial carcinoma, with simultaneous urinary reconstruction (ileal conduit or neobladder). The definitive curative treatment for localised muscle-invasive TCC.

En bloc removal of the entire kidney, ureter, and a cuff of bladder around the ureteric orifice for upper tract urothelial carcinoma (UTUC) of the renal pelvis or ureter. Laparoscopic approach provides equivalent oncological control with reduced morbidity.

An extended pelvic lymphadenectomy encompassing the obturator, external iliac, internal iliac, and common iliac nodes was performed at the time of radical cystectomy for urothelial carcinoma. Provides pathological staging and may confer a therapeutic survival benefit.

Organ-sparing excision of the primary penile tumour with adequate surgical margins, or formal glansectomy (removal of the glans with reconstruction) for tumours confined to the glans or prepuce. Maximises penile preservation while achieving oncological clearance for T1–T2 lesions.

Surgical amputation of the distal penis with a 2 cm clear margin for locally advanced tumours not amenable to organ-sparing surgery, leaving a functional penile stump of sufficient length for standing micturition.

Complete penile amputation for proximal, extensive, or recurrent penile tumours. A perineal urethrostomy is fashioned to allow sitting micturition. Provides the widest oncological margins for very advanced primary disease.

Staged or simultaneous bilateral inguinal lymphadenectomy removing superficial and deep inguinal nodes (and pelvic nodes when involved) for pathological staging and treatment of regional metastatic penile cancer. Sentinel node biopsy is used in clinically node-negative cN0 patients.

Subinguinal ligation of all dilated testicular veins under the operating microscope with preservation of the testicular artery, cremasteric artery, vas deferens, and lymphatics. Improves semen parameters in 60–70% of men and is the most effective treatment for varicocele-associated male infertility.

Fine-needle aspiration of testicular tissue under local anaesthesia to retrieve sperm for use in ICSI. A minimally invasive technique suitable for obstructive azoospermia; less tissue is sampled than in TESE, making it more appropriate for diagnostic or repeat procedures.

Open testicular biopsy in which small pieces of testicular parenchyma are excised and processed by an embryologist to identify and extract viable sperm for ICSI. Performed under local or general anaesthesia for men with obstructive or non-obstructive azoospermia.

The testis is opened under the operating microscope, and individual seminiferous tubules are selectively biopsied from areas appearing most likely to contain foci of spermatogenesis (fuller, more opaque tubules). Sperm retrieval rates in non-obstructive azoospermia are superior to conventional TESE.

Microsurgical reanastomosis of the two cut ends of the vas deferens following vasectomy, restoring continuity of the seminal pathway. Performed under the operating microscope with precision multilayer technique; success depends on the time elapsed since vasectomy.

Microsurgical anastomosis of the vas deferens directly to the epididymal tubule, bypassing an epididymal obstruction caused by infection, trauma, or previous surgery. A technically demanding procedure requiring advanced microsurgical skills, performed when intraoperative findings confirm epididymal blockage.

Non-absorbable sutures (or an ellipse of tunica) are placed on the convex side of the curvature (opposite the plaque) to shorten and straighten the penis. A straightforward procedure for curvature up to 60° without significant shortening or narrowing, with low complication rates.

The Peyronie's plaque is incised or partially excised to release the curvature, and the resultant defect is covered with a pericardial, small intestinal submucosa, or dermal graft. Used for severe curvature (>60°), complex deformities, or cases with significant penile shortening.

A hydraulic inflatable (3-piece) or malleable semi-rigid penile implant is surgically inserted into the corpora cavernosa. Preferred for Peyronie's disease complicated by erectile dysfunction refractory to PDE5 inhibitors, simultaneously correcting curvature during implant dilation and modelling.

A circumferential degloving incision exposes the entire penile shaft, and the rent in the tunica albuginea is identified and repaired with interrupted absorbable sutures. Performed as a urological emergency — immediate surgical repair gives the best outcomes and prevents chronic curvature, erectile dysfunction, and painful plaques.

A surgical anastomosis between a peripheral artery and adjacent vein (most commonly radial artery to cephalic vein at the wrist — Brescia-Cimino fistula) creates a high-flow vascular access site for long-term haemodialysis in patients with end-stage renal disease.

A donor kidney (living or deceased) is surgically placed in the iliac fossa and anastomosed to the external iliac vessels and bladder. Renal transplantation is the definitive treatment for end-stage renal disease, providing superior survival and quality of life compared to dialysis.

A silicone Tenckhoff catheter is surgically or laparoscopically placed into the peritoneal cavity via the lower abdomen to enable peritoneal dialysis — an at-home dialysis modality that uses the peritoneal membrane as the filter, offering independence from dialysis centres.

Surgical removal of a native kidney (laparoscopic or open) before or at the time of renal transplantation — performed for intractable hypertension, recurrent pyelonephritis, massive polycystic kidneys causing abdominal discomfort, or to create space for the transplant.

The cyst wall is excised laparoscopically (unroofed) using scissors and electrocautery, collapsing the cyst and preventing fluid reaccumulation. The preferred surgical approach for large, symptomatic, or recurrent simple renal cysts with very low recurrence rates.

The cyst is drained with a needle under ultrasound guidance, and a sclerosant agent (ethanol or polidocanol) is instilled to ablate the secretory cyst epithelium and prevent refilling. Less invasive than surgery but with higher recurrence rates (30–40%).

Open surgical unroofing of the renal cyst through a flank incision is used for very large or complex cysts, or in cases where laparoscopic access is technically not feasible. Provides definitive treatment with direct visualisation and maximal excision of the cyst wall.

Multiple renal cysts are unroofed laparoscopically to decompress the kidney, reduce its volume, and relieve symptoms of pain, early satiety, and abdominal fullness in ADPKD patients. Does not halt disease progression but provides significant symptomatic benefit.

Laparoscopic or open removal of massively enlarged polycystic kidneys to create space in the retroperitoneum and pelvis for a renal transplant, or to address intractable pain, recurrent haemorrhage, or infected cysts in patients approaching end-stage renal disease.

Placement of a donor kidney (living or cadaveric) in the iliac fossa as definitive replacement of failed polycystic kidneys. Renal transplantation is the best treatment for PKD reaching end-stage renal failure, with excellent long-term graft and patient survival.

A balloon catheter is advanced over a guidewire into the stenotic renal artery under fluoroscopy and inflated to widen the lumen. A metal stent is deployed at the ostium to prevent elastic recoil in atherosclerotic disease. First-line minimally invasive treatment for haemodynamically significant RAS.

A saphenous vein or prosthetic graft is used to create an arterial bypass from the aorta (or hepatic/splenic artery) to the renal artery beyond the stenosis, restoring normal renal perfusion. Reserved for failed angioplasty, long-segment disease, or complex renovascular anatomy.

Open surgical removal of the atheromatous plaque from the renal artery orifice through a transaortic or direct renal arteriotomy approach. Effective for ostial atherosclerotic RAS, particularly in patients already undergoing open aortic surgery.

The ureters are surgically dissected free from the surrounding fibrous retroperitoneal tissue through an open or laparoscopic approach, releasing the ureteral obstruction. The freed ureters are then repositioned laterally or intraperitoneally to prevent re-encasement.

Following ureterolysis, the ureters are wrapped in a pedicled omental flap to provide a protective vascular sleeve, physically separating them from the fibrotic retroperitoneal tissue and reducing the risk of re-obstruction after surgery.

Internal ureteral stents are placed cystoscopically to relieve ureteral obstruction caused by retroperitoneal fibrosis, providing immediate drainage and protecting renal function while medical immunosuppressive therapy takes effect or surgical planning is undertaken.

Emergency antegrade drainage of obstructed kidneys via a nephrostomy tube when retroperitoneal fibrosis has caused severe bilateral ureteral obstruction with impending or established renal failure, serving as a bridge to definitive ureterolysis.

The adrenal gland is removed laparoscopically via a transperitoneal or retroperitoneal approach through small port incisions. The standard surgical approach for most adrenal tumours up to 6–8 cm offers less blood loss, shorter hospitalisation, and faster recovery than open surgery.

Robot-assisted laparoscopic adrenalectomy using the da Vinci system, providing enhanced dexterity and 3D visualisation for dissection around the adrenal vein and adjacent great vessels. Particularly useful for large, complex, or right-sided lesions near the IVC.

Removal of the adrenal gland through a flank, anterior, or posterior open incision. Reserved for large (>8–10 cm) or suspected malignant adrenocortical tumours (ACC) requiring en bloc resection with surrounding structures, or where laparoscopic access is contraindicated.

The AMS 800 urethral cuff is placed around the bulbar urethra through a perineal incision. The pressure-regulating balloon is positioned in the space of Retzius, and the scrotal control pump is through a separate scrotal incision. The most commonly used approach for post-prostatectomy incontinence is

All three components of the AMS 800 (cuff, balloon, and pump) are implanted through a single transverse scrotal incision. A single-incision technique that reduces operative time and surgical site exposure while achieving equivalent functional outcomes.

A polypropylene mesh sling is placed beneath the bulbar urethra through a perineal approach, repositioning and compressing the urethra to improve passive continence. The AdVance and Virtue slings are suitable for mild to moderate male stress urinary incontinence and are less invasive than the AMS 800.

A 15–20 cm segment of ileum is isolated, the ureters are anastomosed to one end, and the other end is brought through the abdominal wall as a permanent urostomy. The most widely performed and reliable urinary diversion after radical cystectomy requires an external urostomy appliance.

A large, low-pressure intestinal reservoir (Studer or W-configured ileal pouch) is constructed and anastomosed to the urethra, allowing continent voiding through the native urethra. Eliminates the external stoma and provides the most natural urinary function after cystectomy.

The appendix (or a tapered ileal tube) is used to create a continent, catheterisable channel from the bladder (or a neobladder) to the umbilicus or abdominal wall. The patient performs clean intermittent catheterisation through this small stoma to empty the reservoir — ideal for those unable to void urethrally.

A continent cutaneous urinary reservoir constructed from the right colon and terminal ileum. The ileocaecal valve is reinforced as the continence mechanism, and the appendix or tapered ileum serves as the catheterisable stoma. Provides continent urinary diversion without a urostomy bag.