Terminology

Please find below a list of the terminology used when discussing your conditions and procedures. Of course, if you have any other questions, please do not hesitate to ask.

Terminology

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  • Urologist
    A Surgeon specialising only in the Uro-genital tract. Therefore all the organs associated with the production, conveying and storage of urine, including continence thereof. Urology also includes the male sexual organs and function thereof.
  • Renal
    Kidneys are the paired bean-shaped organs responsible for filtration and cleansing of your blood. They produce urine.
  • Adrenal gland
    A small gland above each kidney responsible for hormones that help with metabolism, growth, fear-and-fight.
  • Ureters
    Kidney pipes/tubes leading urine from the kidney to the bladder.
  • Bladder
    Also known by its Latin word the Cyst or Vesico which means a fluid-containing sac or organ. Its function is to store and expel urine.

Prostate-specific antigen (PSA)

 An enzyme responsible for taking a clotted ejaculate to a flowable consistency, assisting with fertility. It is used as a marker for prostate disease: BPH, prostatitis and prostate cancer. He cannot differentiate between the 3. Used on its own it is meaningless, yet with serial values it provides a trend making a more useful tool for the diagnosis of prostate cancer. A free to total PSA ratio also assists in differentiating between the 3 above conditions.

Prostate Cancer

 Adenocarcinoma of the prostate. This is the most common solid tumour found in men, with a peak incidence between 65 and 75 years of age. In can be diagnosed as young as 40 years of age in men with a strong family history of prostate cancer and also in certain ethnic groups. It can be cured if found early. Not all cancers require surgery and in certain subgroups it can only be monitored with active surveillance.

  • Urethra
    The tube that conveys urine from the bladder to the opening of the bladder pipe (meatus).
  • Vero Montanum
    The opening of the ejaculatory ducts in the prostatic urethra.
  • Seminal Vesicles
    Small paired ducts behind the prostate and bladder, where the ejaculate is stored. Fructose is produced to feed the sperm cells.
  • Meatus
    Opening of the urethra, tip of the penis in males and between the clitoris and vaginal opening in females.
  • Penis
    Male sexual organ, with 2 functions: a pointer for urination and sexual organ to facilitate procreation.
  • Testes
    2 oval organs found in the scrotum responsible for male fertility. Produces sperm.
  • Scrotum
    The sac below the penis containing the male testes. Also regulated temperature for optimal sperm production.
  • Perineum
    The area between scrotum and anus.
  • Prostate
    An accessory male sexual organ found below the bladder and above your external sphincter (pincher). It sits around the urethra with glandular tubes opening in the urethra. Produces the seminal fluid which helps to create a medium in which the sperm is nurtured for fertilisation.
  • PSA
    Prostate-Specific Antigen is an enzyme produced by the prostate which takes the ejaculate from a clotted to flow-able form helping with fertilisation.

Robotic assisted radical prostatectomy

 A minimally invasive surgical option for management of prostate cancer. It makes working in a constricted area easy and accessible. It magnifies the important structures such as nerves, blood vessels and the urethral sphincter. It provides superhuman flexibility to the robotic arms which makes access easy. The recovery process is so much easier. In my hands it has provided better outcomes for my patients

Focal therapy for prostate cancer

 This is a treatment modality for a single lesion of prostate cancer. This provides localized control with the preservation of the erectile nerves and the urethral sphincter. Unfortunately, prostate cancer is a multifocal disease and therefore is not recommended for everyone. You will require close monitoring afterwards with repeat PSA investigations, repeat MRI imaging and repeat prostate biopsies to ensure that your cancer has been treated completely. No Medicare funding currently available, but hopefully in the near future.

  • Lymph nodes
    Small glands found in strategic places in the body that drain all lymph (clean-up fluid). Most cancers drain to the regional lymph nodes.
  • Vagina
    The female sexual organ as well as the birth canal facilitating the passage of the mature fetus during childbirth.
  • Urothelium
    Umbrella cells that line the inside of bladder, ureters and renal pelvis as well as the urethra up to the distal urethra.
  • Cystoscoele
    The prolapse of the bladder through the front vaginal wall to such a degree that it influences urination and bladder emoications.
  • Enterocoele
    The prolapse of small bowel through the top of the vagina or back wall, being symptomatic.
  • Vault Prolapse
    The top of a previously hysterectomised vagina inverting and pushing to the outside of the vagina.
  • Procidentia
    A fully inverted vagina prolapsing outside the vagina. This could potentially be a dangerous situation and requires urgent review.
  • Rectocele
    The prolapse or herniation of the back wall of the vagina containing the rectum influencing defecation.
  • Cystoscopy
    Looking inside the bladder with a camera.
  • Ureteroscopy
    Looking up the ureters via the bladder.

Benign prostate hypertrophy BPH

A noncancerous enlargement of the prostate, leading to lower urinary tract symptoms (LUTS). This consists of voiding and storage symptoms: Slow flow, nocturia, frequency, urgency and inability to empty your bladder. If left untreated it can cause renal failure, urosepsis and the formation of bladder stones. In worse cases you can go into acute urinary retention requiring urgent placement of a ureteral catheter.

Laser vaporization of prostate: Greenlight laser

 This is a similar treatment as the TURP used for the surgical management of BPH. Also known as the ‘re-bore’. This utilizes a smaller instrument, therefore providing lower risks of a urethral stricture. Less bleeding and shorter catheter times with shorter hospital stays. Prostate cancer is usually excluded prior to doing this procedure. This procedure may encounter more dysuria.

  • CT IVP
    Computed Tomography (Scan) using intravenous dye. An Intravenous Pyelogram is done. The radiographic contrast medium is injected through your veins and is taken in your circulation. It is then excreted by your kidneys which is then the pyelogram. It also delineates the kidneys, collecting systems and ureters.
  • Indwelling Urethral Catheter
    A latex or silicone tube secured in the bladder with a balloon filled with water. Used to drain urine. Usually short-term use yet can be used long-term 8 weeks at a stretch.
  • Suprapubic Catheter
    A catheter placed 2 cm above the pubic bone. Usually for longterm use as with patients with spinal injuries.
  • ISC
    Intermittent self-catheterisation. Where a catheter is used to empty the bladder on a regular basis where there is a neurological problem causing the inability to empty the bladder.
  • ISD
    Intermittent self dilatation: Usually where there is a narrowing in the urethra where a conservative approach is used in treating is with daily dilation using a catheter.
  • LUTS
    Lower urinary tract symptoms consisting of voiding and storage symptoms such as a slow stream, hesitancy, interrupted stream, nocturia, frequency, urgency, etc.
  • BPH
    Benign prostate enlargement with or without LUTS symptoms.
  • Nocturia
    Getting up more than once per night to urinate specifically.
  • Frequency
    Having to use the toilet more than 8 times per day.
  • Urgency
    A sudden uncontrollable desire to urinate, with fear of incontinence.

Minimally Invasive Surgical Therapies – MIST

 A group of therapies using minimally invasive techniques, therefore providing fewer side effects, especially preserving prograde ejaculation. Therapies included in this: Rezum, UroLift, iTind and the UroLume stent. These are generally ejaculation sparing. Yet guys seeking to maintain their fertility would be advised against any surgical intervention at this stage until their families are complete. Erectile function remains unaffected.

Rezum Therapy

 This is a MIST therapy with the injection of stream into the enlarged lateral lobes. This will cause cell damage where it is injected. This causes swelling of the lateral lobes, and you will require an indwelling catheter for a week until the swelling subsides. You may experience persistent urgency and frequency of urination for up to 6 weeks. The end result of the surgery would be seen at 3 months. Currently in my practice I have 6 years efficacy with many happy men.

  • D’Amico risk stratification for prostate cancer
    Low risk:

    • T1-T2a
    • Gleason 3,3;
    • PSA < 10

    Intermediary risk:

    • T2b
    • Gleason 3,4; 4,3
    • PSA 10-20

    High risk:

    • T2c
    • Gleason 4,4
    • PSA > 20
  • Cystogram
    A radiological study where an indwelling catheter is present on the bladder or may be placed in the bladder to administer radiological contrast to asses the anatomy of the bladder, exclude vesicoureteric reflux, posterior urethral valves in kids and to asses the vesicourethral anastomosis after radical prostatectomy.
  • Supine
    Lying on your back.
  • Prone
    Lying face down.
  • Lithotomy
    Lying with your legs up, knees and hips flexed in a 90-degree angle.
  • Hyper-lithotomy
    Lithotomy position with the hips flexed more resulting in the pelvis tilting further forward.
  • Lateral position
    Lying on your side with a 45degree angle with the bed.
  • Bipolar
    An electrocautery in which both active and return electrodes are incorporated into a single handheld instrument, so that the current passes between the tips of the two electrodes and affects only a small amount of tissue.
  • Monopolar
    An electrocautery in which current is applied through a handheld active electrode and travels back to the generator through an inactive electrode attached to the patient (the grounding pad) so that the patient is part of the electrical circuit.
  • Laser Vaporisation
    The process of removing material from a solid (or occasionally liquid) surface by irradiating it with a laser beam.

iTind

Another MIST- therapy. This utilizes the temporary placement of a stent inside the prostatic urethra. The stent will cause strategic scarring at 3 points in the prostate which will keep the cavity open. It generally provides relief of urinary symptoms for up to 5 years. It is repeatable.

Overactive bladder

This is generally described by the acronym FUN: frequency, urgency, urge incontinence and nocturia. The urge incontinence is usually depicted by large volumes of leakage which occurs with no warning. It consists of about 30% of patients who suffer with incontinence and is usually managed with medications and lifestyle changes consisting of physiotherapy as a first-line. Advanced therapies are available in the form of sacral neuromodulation, intravesical BOTOX and posterior tibial nerve stimulation.

  • TRUS
    Trans Rectal Ultrasound guided Prostate visualisation and guided prostate biopsies.
  • Fudicial Marker
    Usually, a gold seed that is placed via TRUS in the prostate to mark the peripheral areas of the prostate enabling safe radiation.
  • Prophylactic Antibiotics
    Antibiotics that are given before surgery to prevent infection.
  • Anti-coagulation therapy
    Therapy with Warfarin or Clexane working on the clotting cascade.
  • Anti-platelet therapy
    Medications such as Asprin and Plavix that disables the function of platelets.
  • Laparoscopic Procedure
    A procedure is done with intra-abdominal cameras and ports, a minimally invasive technique.
  • Open Surgery
    A cut of variable lengths made to access any urological organ to facilitate treatment.
  • Endoscopic Procedure
    A camera procedure of the internal aspects of the bladder, prostate ureters and kidney. Usually done through the natural orifice of the urethra, occasionally through a puncture site through the back into the kidney.
  • General anaesthesia
    The Anaesthetist will put you to sleep and also paralyse your muscles and support your breathing using a ventilator.
  • Regional anaesthesia

    A part of your body, usually the lower half of your body is paralysed and desensitised using a spinal injection of a local anaesthetic (Spinal / Epidural).

Sacro Neuromodulation SNM

 This involves the placement of an electrode through the third sacral foramina to stimulate the S3 nerve which attenuates bladder and rectal function. 7 programs are provided on a battery placed under the iliac crest subcutaneously. The device communicates with a hand-held device which allows changes to be made on the device. This therapy offers up to 80% improvement for the overactive bladder and detrusor sphincter dyssynergia. Up to 50% improvement for the underactive bladder. There is no 100% cure for anyone.