Glossary

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Abdominal or bladder pain: pain in the suprapubic or retropubic area, which usually increases with filling of the bladder and may persist after voiding. The abdominal or bladder pain is often associated with urinary tract symptoms or with acute urinary retention.
 
Anterior urethra: The male urethra is divided into the anterior and posterior urethra. The anterior urethra is divided into the navicularis, penile and bulbar urethra, and extends from the distal external urethral sphincter to the external urinary meatus. The posterior urethra can be divided into the membranous and prostatic urethra and consists of the segment that extends from the bladder neck to the distal external urethral sphincter. The posterior urethra includes the two urinary sphincters, at the level of the bladder neck (proximal urinary sphincter) and at the level of membranous urethra (distal urinary sphincter).
 
Bulbar urethra: The bulbar urethra, located inside the perineum and scrotum, extends from the external distal urinary sphincter to the peno-scrotal junction, and is surrounded by the corpus spongiosum. It contains the opening of the ducts of the Cowper glands, and differs in length from person to person.
Diverticulum: Congenital urethral diverticulum or duplication are normally located in the bulbar urethra. Dilation of the bulbar cause postvoiding dribbling during micturition.
 
Dysuria: frequency, pain or burning on urination. The patient may complain of difficulty, burning, and pain when passing urine through the urethra. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder. The symptoms are alleviated using antispasmodic or pain-relieving drugs. The use of antibiotics is suggested only after a urine culture, as urinary tract infection may be the cause of dysuria.
End to end anastomosis: The surgical technique of “End-to-end anastomosis” is made by transecting the urethra at the level of the stricture site, removing the scar tissue and performing a direct anastomosis between the two urethral edges. This surgical technique is one of the fist operations described in the repair of urethral strictures.
 
Epididymitis: infection and inflammation of the testis and epididymis. Orchitis-epididymitis may arise suddenly and is associated with a high temperature. The fever is often associated with acute urinary retention, dysuria, voiding difficulties or abscess and phlegmon. The patient complains of painful and bulky testis, and reddening of the scrotal skin. Orchitis and epididymitis re normally due to urinary tract infection which arrives to the testis through the deferent. When the orchitis and epididymitisis are associated with a high temperature the patient shoul consult a doctor.
 
First stage of Johanson procedure: The surgical technique of “First stage of Johanson procedure” is to open the urethra, leaving for ever the external urinary meatus further down.
 
Fistula:fistula is an abnormal opening of the urethra in to the penile shaft or perineal area. In patient with urethral fistula the micturiction is both from meatus and fistulous opening.
Genitalia itching: irritation or itching in the penile skin or glans or inside the urethra. Genitalia itching is frequently associated with dermatological skin lesions, mainly lichen sclerosus disease. The use of medicinal creams may be useful to alleviate the symptoms, but the patient should consult a dermatologist. If there are no skin lesions, itching along the inside of the penis or on the tip of the glans may be due to infection or urethral stricture.
 
Hypospadias: Hypospadias is a congenital malformation of the male and female genitalia, resulting from incomplete development of the urethra. The term hypospadias is derived from the Greek language and refers to an opening on the ventral surface of the penis that is not at the apex of the glans. The abnormal urethral opening may be anywhere along the shaft of the penis or may be on the scrotum, or even in the perineum. Hypospadias may be associated with curvature of the penis during erection.
Intermittent urinary stream: the urinary flow and stream stop and start on one or more occasions during micturition. The urinary stream is fine and micturition is possible only using the abdominal muscles, as in stool evacuation. Post-voiding dribbling is also present. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder or chronic urinary retention.
 
Ischemia:ischemia is a poor vascular blood supply to the urethral tissues. Some type of urethroplasty may damage the vascular blood supply to the urethra causing ischemia. Prolonged ischemia, as in patients who underwent cardio-vascular surgery, may cause urethral stricture.
Lichen sclerosus: Lichen sclerosus cause destructive scarring that can lead to urinary and sexual problems and a decrease of quality of life. Symptoms are pruritus and soreness, difficulty in retracting the foreskin and a poor urinary stream. Examination shows typical flat, atrophic, ivory to white colored papules that coalesce in plaques of varying sizes, commonly with a non-retractile prepuce and meatal stenosis.
Male urethra: The urethra is a tubular structure that serves to bring to the exterior the urine contained in the bladder and seminal fluid from the prostate gland and seminal vescicles, which contains spermatozoa. The urethra originates in the bladder, at the inferior and anterior level, called bladder neck. After crossing the pelvic floor and the perineum, it runs along the entire length of the penis, ending at the apex of the gland. The length of the male urethra varies according to age and from person to person. In adult men, the length of the urethra, about 16-18 cm, varies also according to penile length. The male urethra can be subdivided into various tracts.
 
Meatoplasty: The surgical technique of “Meatoplasty” is made by opening the meatus, widening the urethral lumen by applying a skin or oral graft. There are three basic types of Meatoplasty:
Meatoplasty using skin flap. Using this technique, the urethral meatus is augmented using a penile skin flap.
Meatoplasty with oral mucosal graft. Using this technique, the urethral meatus is augmented by a transplant of an oral graft.
Meatoplasty with skin graft. Using this technique, the urethral meatus is augmented by a transplant of a skin graft.
 
Meatotomy: The surgical operation named “Meatotomy” is performed opening the external urinary meatus, thus leaving the new urethral opening further down, along the ventral surface of the penis.
 
Membranous urethra: The membranous urethra is about 1.5 cm in length and is located inside the urogenital diaphragm. It is in anatomical relationship with the external distal urinary sphincter.
 
Navicularis urethra: The navicularis urethra extends inside the glans up to the external urinary meatus and is surrounded by the corpus spongiosum of the glans. Inside the navicularis urethra, the fossa navicularis and the Guerin’s valve can be found.
 
Necrosis:necrosis is an irreversible damage to the tissues, due to inadequate arterial vascular supply to the tissues. Some type of penile urethroplasty my damage the arterial vascular blood supply to the penile skin, causing skin necrosis.
 
Nocturia: frequency of urination at night. During the night, the patient wakes up every hour or more frequently to go to the toilet. Also, difficulty in initiating micturition resulting in delayed onset of voiding is experienced. The patient is ready to pass urine but the urinary stream does not easily start or it starts with only a few drops of urine which later become a very thin flow. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder or chronic urinary retention.
Orchitis: infection and inflammation of the testis and epididymis. Orchitis-epididymitis may arise suddenly and is associated with a high temperature. The fever is often associated with acute urinary retention, dysuria, voiding difficulties or abscess and phlegmon. The patient complains of painful and bulky testis, and reddening of the scrotal skin. Orchitis and epididymitis re normally due to urinary tract infection which arrives to the testis through the deferent. When the orchitis and epididymitisis are associated with a high temperature the patient shoul consult a doctor.
 
Penile urethra: The penile urethra extends from the peno-scrotal junction to the base of the glans. It is surrounded by the corpus spongiosum, is mobile and is stretched during penile erection The length of the penile urethra varies according to penile length.
 
Perineal Urethrostomy: The surgical technique of “Perineal urethrostomy” is to create a new urethral opening via the perineum, just above the anus, thus avoiding that urine need to travel through the entire length of the urethra. Using this technique the male urethra, 12-18 cm long, becomes similar to the female urethra, 5-6 cm long. This change permits that the bladder requires a shorter tract to push out urine.
 
Periurethral abscess: pus in the scrotal or perineal tissues. A urinary tract infection may be complicated by an abscess or phlegmon. The patient also complains of having a urinary tract fever, voiding difficulties or urine retention. In the penile, scrotal or perineal area a hot round mass, with reddened skin may be palpated. A patient showing these symptoms must immediately go to the hospital.
 
Phlegmon: pus in the scrotal or perineal tissues. A urinary tract infection may be complicated by an abscess or phlegmon. The patient also complains of having a urinary tract fever, voiding difficulties or urine retention. In the penile, scrotal or perineal area a hot round mass, with reddened skin may be palpated. A patient showing these symptoms must immediately go to the hospital.
 
Posterior urethra: The male urethra is divided into the anterior and posterior urethra. The anterior urethra is divided into the navicularis, penile and bulbar urethra, and extends from the distal external urethral sphincter to the external urinary meatus. The posterior urethra can be divided into the membranous and prostatic urethra and consists of the segment that extends from the bladder neck to the distal external urethral sphincter. The posterior urethra includes the two urinary sphincters, at the level of the bladder neck (proximal urinary sphincter) and at the level of membranous urethra (distal urinary sphincter).
 
Post-voiding dribbling: at the end of micturition, some drops of urine leak out. The patient urinates without difficulties or particular problems, but at the end of micturition, some drops of urine leak and wet his trousers.
 
Post-voiding urine retention: after micturition, the bladder is not completely empty. Urinary retention is classified as acute or chronic. When acute urinary retention occurs, the patient is unable to urinate and must go immediately to the hospital. Chronic urinary retention occurs when the patient is unable to completely empty the bladder, which may cause pain in the suprapubic or retropubic area.
 
Prostatic urethra: The prostatic urethra is inside the prostate gland and extends from the bladder neck to the veru montanum. In the adult, the length of the prostatic urethra is about 3 cm, but in children it is shorter and in patients with prostatic enlargement it is longer.
Retrograde urethrography: A small catheter is positioned in the urethra and the contrast medium is injected through the catheter to visualize the urethral canal. This exam does not require any preparation, but it must be performed with the full cooperation of the patient, who is required to tolerate the discomfort of the catheter and the contrast medium flowing through the urethra. Patients with a history of a previous allergic reaction to the contrast medium (iodine) need to inform the doctor prior the investigation.
Slow urinary stream: urinary stream is slow, weak and does not even reach the water but falls on the patient’s shoes. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder.
 
Splitting or spraying of the urinary stream: the urinary stream is fine and forked. This symptom is typical in patients with meatal or urethral strictures. The patient complains that the urinary stream is irregular, fine and forked and wets his trousers.
 
Straining to voiding: muscular effort used to initiate, maintain or improve the urinary stream by using abdominal muscles, as in stool evacuation. Using muscular abdominal nisus the urinary stream is also poor, stop and go and post-voiding dribbling is present. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder.
 
Two-stage urethroplasty with oral mucosal graft: The surgical technique of “Two-stage Urethroplasty with oral mucosal graft” is conducted in two operations performed at different times. During the first operation, the urethra removed and replaced by an oral mucosal graft (figure 2) and the external urinary meatus is moved further down. One year later, the urethra is closed and the patient is again able to void through the external urinary meatus at the apex of the glans.
Urethral stricture: The male urethra is a tubular structure about 18 cm in length, and it may present an occlusion or reduction of his caliber that is called urethral stricture. Male urethral stricture may be due to congenital abnormality or acquired diseases.
 
Urethral Ultrasonography: This exam is performed using an auxiliary ultrasonic probe that is placed on the penis or perineum. It is a simple and entirely painless exam, which does not require any specific patient preparation.
 
Urethrography: This radiological examination of the urethra is performed with the use of contrast medium. Retrograde and voiding urethrography is the most basic exam for studying the urethra. Non- urethral surgery can be planned without having performed this exam.
 
Urethroscopy: This procedure is performed in an operating room with the patient under anesthesia to allow for an easy and painless exam. The examination consists in introducing a metal instrument into the urethra in order to visualize the urethral canal from the inside. The instrument, which can come in different sizes, is inserted into the external urethral meatus and is carefully moved through the urethra until it reaches the bladder.
 
Urethrotomy: The surgical technique of “Urethrotomy” creates a widening of the urethra using a special instrument. The operation is performed endoscopically through the external urinary meatus, progressing up to the area that narrows, without invasive surgery.
 
Urgency: a sudden compelling desire to pass urine which is difficult to defer. Urgency is often associated with urge incontinence and the patient complains of a strong and urgent stimulus to urinate, the inability to reach the toilet and starting micturition beforehand.
 
Urinary frequency: urinating too often. The patient is must urinate every hour or more frequently during the day and/or night (Nocturia). Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder. The symptoms are alleviated using antispasmodic or pain-relieving drugs. The use of antibiotics is suggested only after a urine culture, as urinary tract infection may be the cause of urinary frequency. Urinary frequency may be associated to dysuria.
 
Urinary hesitancy: difficulty in initiating micturition resulting in delayed onset of voiding. The patient is ready to pass urine but the urinary stream has difficulty starting or starts with only some drops of urine which later become a very thin flow. Pain in suprapubic or retropubic area may be present due to incomplete emptying of the bladder.
 
Urinary incontinence: involuntary leakage of urine. The patient is forced to use a large incontinence pad or a small diaper to protect the trousers. Urinary incontinence is classified as stress incontinence, urge incontinence and total urinary incontinence. Stress incontinence occurs under strain (cough, sharp movement, strain to lift a weight, etc.). During urge incontinence, the patient complains of a strong and urgent stimulus to urinate, but is unable to reach the toilet and starts micturition beforehand. Total urinary incontinence is due to surgical damage to the urinary sphincters after prostatic surgery.
 
Urinary tract fever: related to urinary tract infection. A urinary tract fever is a high fever (> 39°) associated with shivers. The fever starts suddenly and immediately reaches a high temperature making the patient’s teeth chatter from the cold. A urinary tract infection is often associated with acute urinary retention, dysuria, voiding difficulties or abscess and phlegmon.
 
Uro-flowmetry: A simple investigation that can be performed in the urological out-patient office. The patient urinates normally into a special container connected to a computer, that registers the volume and velocity of the urine stream. To perform this test, no specific preparation of the patient is required, except for a full bladder in order to urinate.
 
Valve: The urethral valve is an anomaly of the urethral mucosa, than can cause partial or complete obstruction of the urethra. The urethral valves are located in the posterior urethra and are often associated with complex malformations of the kidney, ureter and bladder. The urethral valve is rarely located in the penile or bulbar urethra. They can be located using ultrasonography during pregnancy.
 
Voiding cystourethrography: Once the bladder is filled with the contrast medium, the patient is asked to urinate in order to visualize the urethral canal.
 
Voiding difficulty: the urinary stream is poor and the patient strains to void using muscular abdominal nisus to either initiate, maintain or improve the urinary stream. The patient complains that he is able to urinate using only the abdominal muscles as in stool evacuation. Using muscular abdominal nisus the urinary stream is also poor, stop and go and post-voiding dribbling is present. Pain in the suprapubic or retropubic area may be present due to incomplete emptying of the bladder.