Explore the animations.

The delayed perineal repair of a pelvic fracture urethral injury: the scar excised onto a sound, the gap bridged step by step, a tension-free anastomosis.

Dorsal onlay buccal graft for a female stricture, with the sphincter and the vaginal wall left alone.

A spinal-injured man with dyssynergia: the cut at twelve o’clock from the verumontanum through the full sphincter into the bulbar urethra, the venous plexus and spongiosum left alone, dysreflexia watched for.

A tape under the mid-urethra, each arm carried up the back of the pubis on a trocar: the bladder drained and looked at before the tape is drawn, and the tape left loose.

The sac out whole at its neck, then three layers back: the urethra along, the fascia across, the vaginal flap over both.

A strip of rectus sheath under the bladder neck: the finger tunnel behind the pubis, cystoscopy before the tie, and a loose knot.

Native-tissue cystocele repair: a midline plication that lifts the bladder, the fascia sutured back to the arcus on each side.

A native-tissue posterior repair: the fascia plicated over the rectum, the calibre checked before closure.

The vault brought out and the enterocele opened; three sutures through each uterosacral ligament lift the apex, then cystoscopy for ureteric efflux.

A fistula at the vault after hysterectomy, closed through the vagina: an inverted-U flap, the tract excised, two crossed bladder layers and the flap advanced as a third.

Ureters catheterised, bladder parted from the vault, two crossed closures, omentum laid between.

A meatus at the corona on a straight penis. The bridge beyond it cut vertically and closed across, the ventral edge lifted on a hook, the glans closed under it in three layers. Nothing is tubularised.

The plate kept flat, an island of inner prepuce on its dartos pedicle carried round the shaft and laid on it. The pedicle is the lesson.

Reflux repaired from outside the bladder: the obliterated artery divided, the detrusor split down to a bulging mucosa, the ureter laid in and the muscle closed loosely over it. The bladder is never opened.

Reflux that will not settle: the ureter taken out of its own hiatus, round behind the bladder and in through a new one higher up, then tunnelled down to open where it always did.

A ureter too wide to reimplant as it is: freed inside the bladder and then outside it, its narrow end removed, a strip of lateral wall excised over a catheter away from the medial vessels, and the tapered ureter drawn across the trigone under the mucosa.

An infected, obstructing ureterocele in a young child: one low transverse cut through the full wall, a jet of urine, and the bladder neck left alone.

The scar excised, both ends opened dorsally, the ventral walls joined in two layers and an oral graft quilted to the corpora in the dorsal diamond.

The whole urethra out through the perineum after cystectomy: off the corpora to the glans, the meatus cored out, the bulbar arteries tied, the stump freed from under the bowel.

A rectourethral fistula after prostatectomy, repaired from behind: each sphincter layer divided and marked with its pair, the track excised, three suture lines that do not overlie, every layer tied back to its partner.

A ring of distal penile skin on its dartos pedicle: two cuts in two planes, the ring opened to a strip, brought round and turned over on to the opened urethra, skin to the lumen.

A transobturator sling after prostatectomy: the bulb bared, the central tendon cut, a helical passer round each ramus, the body fixed on the bulb and the bulb drawn up.

The post-prostatectomy pelvis: the plane on the white tunica, the cuff sized without squeezing, the balloon in Retzius, the pump dependent, cycling and the six-week deactivation. Erosion, infection and the atrophy that leaks again.

Reflux that will not settle: the ureter freed on its cuff, drawn across the trigone under the mucosa, and sewn in on the far side. No twist, no kink, no tension.

An inverted-U flap turned into a ventral bulbar urethrotomy. A broad base, the apex stitch, mucosa to skin all round; stenosis is the late failure.

Map, exophytic tumour, base down to detrusor, the lateral-wall obturator moment and the ureteric orifice in the field.

Short strictures excised and joined; long ones grafted from the cheek. Tension is the enemy.

Two weeks after the resection, a dry bladder, an atraumatic catheter, the dose held for two hours; the six then the maintenance, the cystitis that is expected and the fever that is not.

Fibre or stone punch, evacuate, then ask why it formed. The punch closes only on a stone lifted to the centre of the bladder, never against the wall.

Two curves and a sphincter, done blind: gel and time, the penis held up then lowered, breathing at the sphincter, to the hub and urine before the balloon. The ladder to climb when it will not pass.

The stricture ring, the wire through the lumen, the 12 o’clock cold knife and why the spongiosum decides the position.

A filled bladder, a clear window and a midline track. The bowel between the wall and an empty bladder is the whole danger.

A dome-to-wall injection map that spares the trigone. Retention is planned for, not discovered.

A properly filled cystogram, then the intraperitoneal from the extraperitoneal decision, and the fixator that blocks the track.

Blood at the meatus, a gentle study, a suprapubic drain and a reconstruction planned for months later.

Mid-urethra, para-urethral tunnels, the trocar through the obturator foramen, and the retropubic danger it avoids.

The plate incised, tubularised, covered. The fistula is the complication every parent asks about.

S3 foramen needle, motor responses, tined lead and the two-stage trial. Wrong level, infection, migration.

The appendix becomes a catheterisable channel with a flap-valve tunnel. Stenosis is the long-term enemy.

The vault lifted to the promontory. Presacral veins, ureters, and the mesh that must be covered.

The bladder out, the bowel in, the stoma marked. Rectum behind, ureters above, venous plexus below.

The ureter at the brim with its adventitia, the bladder mobilised and drawn up to the psoas and hitched past the genitofemoral nerve, a spatulated reimplant over a stent, and the Boari flap for the gap the hitch will not close.

Bladder, prostate and rectum out as one piece: the sidewall planned, the internal iliacs ligated beyond the superior gluteal, the perineal phase from below, a conduit and a colostomy, and a flap so the pelvis is never left empty.

The infant resectoscope below the veru, the leaflets at five and seven o'clock, a cold knife or a bugbee on the lowest setting through each, the sphincter a millimetre behind, and the check cystoscopy at three months.

A wire through the pinhole first, then a cold knife at three and nine o'clock deep enough to see the fat and no deeper, steroid or mitomycin into the cuts, and the sphincter untouched; the ladder for the one that recurs.

The needle a centimetre below the neck, submucosal at three and nine until the lumen closes to a slit; nothing cut, nothing burnt, a second sitting expected and the retention that is treated by catheter, not by dilatation.

Mitomycin within six hours of the resection, held for an hour: the bladder surveyed for a perforation before a drop goes in, because extravasated mitomycin is the complication that cannot be undone.

Two lines and a rectal catheter, the fill at a physiological rate, the cough that proves the trace is live, detrusor pressure as the number that matters, and the leak on the screen that changes the plan.

The bladder bivalved like a clam from neck to trigone, twenty centimetres of ileum opened along its border and folded into a cup, sewn to the rim watertight, and the catheterisation, mucus and acidosis that follow for life.

Fifty-five centimetres of ileum, forty detubularised and folded into a sphere, the proximal fifteen kept as the afferent limb for the ureters, and the dependent point sewn to the urethral stump over a catheter.

The right colon opened along its taenia and closed as a reservoir, the terminal ileum tapered over a 12 French catheter and the valve plicated, the ureters into the back wall, and a flush stoma catheterised for life.

The outlet that cannot be saved: the neck dissected off the prostate, the urethra divided, both ends closed in layers with omentum laid between them, and the suprapubic or the channel decided before the first cut.

The urethra under vision, the air bubble as the compass, the survey in a fixed order, retroflexion for the anterior neck, a papillary tumour mapped for TURBT and a stent out through the working channel.

The sheath in on the obturator, the 30 and the 70, a cold-cup bite taken unburnt, the button on the bleeding point, and mapping biopsies from named sites each in their own pot.

The patient before the catheter, the bedside washout, the Ellik through a 26 French sheath without over-filling, the bladder surveyed before the prostate is blamed, arteries at their point and ooze to the catheter.

Supine, one upper scrotal incision: the corpora followed to the bulbar urethra, the cuff sized and locked, the balloon carried through the external ring, the pump dropped into a dependent pouch, then deactivated. Distal cuff, tight sizing, high pump and the catheter rule.

A Z-Anatomy-derived male pelvis: ureters over the bifurcation, vesical pedicles off the anterior division, the posterior plane on Denonvilliers, the obturator fossa cleared.

Benign disease, open approach: the wall layer by layer, the trigone kept, a fifteen centimetre ileal segment, Bricker anastomoses over stents and a spouted stoma on the closed abdomen.

The enucleation plane, the three lobes, the sphincter moment at the apex and morcellation in a full bladder.

Bladder neck, seminal vesicles, Denonvilliers’ plane, nerve-sparing pedicles and the apex. Rectum, ureter and anastomotic leak.

Nothing cut and nothing left: three struts at twelve, five and seven with the leaflet at six under the neck, five to seven days of pressure, then out on its retrieval suture.

The distal lobe anchors in the bladder and the reinforced neck locks on the bladder neck; the working lobe splits the anterior commissure at twelve, then paclitaxel for five minutes so it does not fuse back.

The MRI first, the probe in the rectum and the grid on the perineum, the block at the apex, targeted cores through the lesion, systematic cores by sector, and the apex and anterior gland that the transrectal needle never reached.

The hundred-gram gland: the dorsal venous complex stitched above and below, a transverse capsulotomy, the adenoma swept off the capsule and pinched off at the apex, sutures at five and seven o'clock, and the capsule closed over a three-way catheter.

The CT angiogram is the operation: over the bifurcation into the anterior division, the prostatic artery found where it was drawn, cone-beam CT for the branch to rectum, bladder or penis, microspheres to stasis, and the other side.

The lesion and its margin, short of the rectal wall, the urethra and the sphincter: HIFU from the rectum or cryotherapy from the perineum with the urethral warmer running, watched at the edges, the other side and the bundle spared.

The small gland and the high neck: a Collings knife at seven and five o'clock from inside the neck to short of the veru, deepened until the fat shows, and the neck springs open.

Goggles on, the side-firing fibre a millimetre off the tissue with the bubbles as feedback: median lobe, both laterals, the apex last from the veru. For the man on anticoagulants.

Nothing cut: implants fired through each lateral lobe at ten and two, from 1.5 cm inside the neck to a centimetre short of the veru, the lobes held apart and ejaculation kept.

A needle a centimetre into the transition zone and nine seconds of steam, treatments a centimetre apart from the neck to the veru, the median lobe from the neck; a catheter expected and the result in weeks.

The contour drawn on the ultrasound from the veru and the orifices, the jet in four to six minutes, then the bleeding that is the surgeon's: focal cautery at five and seven and a catheter on traction overnight.

The film anatomy made interactive: unlock the camera, find the veru and both orifices, take the median lobe from the neck, release and drop each lateral lobe, the apex from 12 o'clock, Ellik, button haemostasis and the three-way catheter.

A lower-pole stone broken from outside: coupling, targeting, the energy ramp, fragmentation, and what the fragments do next.

Biopsy and laser ablation of a renal pelvic urothelial tumour with the kidney kept, and the second look that follows.

A collection between the graft and the bladder: the fluid creatinine against the serum, a percutaneous drain, and when it comes back a laparoscopic peritoneal window cut away from the transplant ureter.

The non-functioning kidney removed laparoscopically through three small ports, then the upper-pole heminephrectomy of a duplex kidney with the lower moiety kept.

A child with a stone: ultrasound and the metabolic screen, the route by size and site, an ultrasound-guided mini-PCNL with one small tract and the washout, and ureteroscopy for a lower-ureteric stone.

One ureter joined to the other: the donor divided above the disease, drawn through a tunnel in front of the great vessels above the inferior mesenteric artery, and sewn end to side to the recipient.

No pelvis left to rebuild: the lower pole amputated to lay the dilated calyx open, the healthy ureter spatulated and sewn to it mucosa to mucosa over a stent.

The ureter trapped in retroperitoneal fibrosis: found above the plaque, biopsied, freed from above downwards with its adventitia on it, laid in the peritoneal cavity and wrapped in omentum.

A long ureteric loss replaced with ileum on its pedicle: chosen against the light, laid isoperistaltic, joined to the pelvis and the bladder. The pedicle is the operation.

Where the uterine artery crosses and at the brim: blue dye and a retrograde on the table, the clip off, the burn excised, the late urinoma drained and a nephrostomy placed, and repair by level when the patient is ready for it.

Access sheath, systematic calyx mapping, lower-pole dusting. Perforation, pressure-driven backflow and the bleed that takes the view.

CT planning, calyceal puncture, tract dilation, clearance and drainage. Pleura, colon and the bleed that needs embolisation.

The crossing vessel at the PUJ, dismembering, transposition and the anastomosis over a stent.

Safety wire first, a second wire through the semirigid scope, the ureter tented on both and the scope railroaded up the left ureter. Dusting, never large fragments; clearance by gravity, basket if needed; a selective stent. Perforation, avulsion and the impacted stone.

Kidney and whole ureter with a true bladder cuff. No-touch, because spillage seeds.

The left kidney off Gerota with the colon reflected, the gonadal vein as the road to the hilum, the golden triangle kept on the ureter, the adrenal and lumbar veins clipped, the artery clipped close to the aorta, the vein stapled flush with the cava, and clip to ice.

Brain death or circulatory death and their two clocks: the aorta and cava slung and cannulated, cross-clamp and cold perfusion, ice around every organ, the kidneys en bloc with Gerota on and the ureters long, then separated on the bench, packed and documented.

The kidney off the bench into the right iliac fossa: the lymphatics tied, the vein end to side, the artery on its patch, the reperfusion that pinks and passes urine within minutes, and the ureter into the bladder over a stent.

Supine, one position, two scopes: retrograde and percutaneous at the same time. The colon moves when the patient does.

Decompression of the obstructed system through a posterior calyx. Retrorenal colon, segmental arteries and the transpleural line.

The stent that never came back, crusted from both ends. Decrustation, staged removal and the register that prevents it.

One kidney, five grades and the decisions between them: embolise, explore or watch. The case that teaches the thresholds.

The small posterior mass in the wrong patient for surgery: biopsy first, the colon floated away with fluid, two or three probes through the mass to its far edge, the ice ball watched past the margin and against the collecting system, and the track ablated on the way out.

The tongue of tumour up the vein and into the cava: the level on MRI sets the team, the artery ligated first, three loops on the cava below, the other renal vein and the cava above, clamps in order, the cavotomy up the anterior wall, the thrombus out whole and the cava closed wide.

A donor nephrectomy and a transplant on the same patient: the vessels taken long, the aneurysm or the artery repaired cold on the bench under loupes, vein then artery in the iliac fossa, a Doppler on every branch, and the pelvis sewn to the bladder when there is no ureter.

The failed graft that hurts, bleeds or infects, through the old Gibson scar: the subcapsular plane, the graft shelled out with the finger, the hilum clamped as one and oversewn in two layers with the iliac vessels a blind clamp away, the ureter tied near the bladder, the capsule left behind.

A creatinine up a fifth and only the tissue tells rejection from the drug, the virus or the recurrence: the superficial graft under ultrasound, cortex at a pole away from the hilum, a two centimetre throw along the cortex, two cores checked for glomeruli, then bed rest and the haemoglobin.

The pelvis too big because the junction will not empty, operated on for symptoms, falling function or growth: the ureter by its adventitia, the lower-pole crossing vessel found and kept, the junction excised, the pelvis reduced, the ureter spatulated and joined dependently over a stent with 6-0 or 7-0.

Stone, fever and a falling pressure: sepsis six and the call to drain made at the same time, CT without contrast, prone under local for the posterior lower calyx below the twelfth rib or a stent from below under anaesthetic, minimum contrast, the pus out tonight and the stone treated weeks later.

The short mid-ureteric stricture: the ureter mobilised enough to meet and no more, excised to bleeding ends, spatulated on opposite sides, joined over a stent without tension, and wrapped in omentum or fat.

The ureter with the worst blood supply of any: the leak early, the stricture late, a nephrostomy and an antegrade stent first, then a redo reimplant, the native ureter to the graft pelvis, or a Boari flap up to the graft.

The orifice centred, contrast gently, the wire that must curl in the renal pelvis, the stent over it with the pusher holding, both curls seen, and the register that stops it being forgotten.

Artery first, vein second, upper pole and neighbours. The renal vein tear, the spleen and the pancreatic tail.

Clamp, pale kidney, tumour out with a rim, two-layer renorrhaphy, reperfusion. Margin, urine leak and the delayed bleed.

One midline puncture, each vas delivered and confirmed, clipped, divided, cauterised and buried in its sheath at one end.

A radical open groin dissection for penile cancer: thick flaps, the packet from below, the saphenous vein kept, the deep nodes and Cloquet, the sartorius transposed.

Compression and manual reduction under a block; punctures and a dorsal slit of the band when it fails; a ring or hair tourniquet as the differential.

Each vas delivered through one raphe incision, the scar cut out, the testicular fluid checked for sperm, and a two-layer vasovasostomy; the vasoepididymostomy as the no-sperm branch.

Surgical sperm retrieval in non-obstructive azoospermia: equatorial incision, tubules chosen under the microscope, the embryologist's verdict.

The cyst freed from the head of the epididymis on the cyst wall, its neck tied clear of the testicular vessels; epididymectomy from tail to head.

Sized to the other testis, placed in a dependent pouch through a high incision, fixed at the bottom and kept down by a neck purse-string.

Ultrasound, haematocele evacuated, tubules trimmed, tunica albuginea closed; a flap or orchidectomy when it cannot be.

Escutcheonectomy and fixation of the penile base, excision of skin scarred by lichen sclerosus and a split skin graft; graft loss, wound breakdown and reburial as triggers.

Primary closure in the modern staged repair: the plate freed, the outlet tubularised, the bladder closed and dropped, the pubis brought together after osteotomy.

The fascia is worse than the skin: the finger test, excision to bleeding edges, the second look and thigh pouches.

Posterior sagittal repair of a cloaca: the channel length decides, the rectum is separated, the urogenital block comes down whole.

Staged radial forearm phalloplasty: urethral lengthening, the join of pars fixa to pars pendulans, and its complications.

The urological parts of feminising genital surgery: orchidectomy, the rectoprostatic space, the neoclitoris, the new meatus and the skin-lined canal; rectal injury, meatal stenosis and spraying as triggers.

Herniotomy in an infant: the canal opened along its fibres, the nerve kept, the sac freed from the vas and the vessels and tied at the deep ring.

The part out of iced water, the two cut faces lined up on a catheter, then joined from the inside out: corpora, urethra, vein, artery, nerve, skin.

The whole penis for a cancer too proximal for a stump. Urethra divided long, each crus divided and closed, the end drawn beneath the scrotum to a wide perineal opening.

Inferior epigastric artery to the dorsal artery, end to side under the microscope. Selection is the operation; a twist in the tunnel is the failure.

Sixteen dots either side of the deep dorsal vein, four sutures through tunica only, folds that take the bend out. The second erection is the proof.

The open shunt after the ladder has failed: a transverse glans incision, a window in each corporal tip, bright blood as the endpoint.

One rod in each corpus and nothing else. The lateral wall, the two readings, the fold and the bend.

The buckling moment, the tear in the ventrolateral tunica, the degloving that finds it.

Inguinal, never scrotal: delivery through the canal, high ligation at the internal ring, the ilioinguinal nerve on the cord.

Drain, evert the tunica behind the testis and cord, close loosely enough for a little finger. The haematoma is the complication the dressing is for.

Dorsal slit, frenular artery, sleeve excision and the suture line. Bleeding, glans and urethral injury, meatal stenosis.

The post-chemo mass on the great vessels. Lumbar veins, sympathetic chains, chyle.

The bell-clapper cord, derotation, the viability decision and bilateral fixation. Time is tissue.

Coils up the vein or ligation below the ring. The lymphatics decide the hydrocele.

Down the canal without tension into a sub-dartos pouch. The vessels set the limit.

Aspirate, irrigate, sympathomimetic, then the distal shunt. The clock decides the outcome.

Two cylinders, a pump, a reservoir. Dilation crossover and the paravesical corner.

A clear margin with the function that remains. Spatulated urethra, reconstructed tip.

The endocrinologist first, then the spleen and pancreatic tail rotated off the gland as one, the adrenal vein clipped before the gland is disturbed, the gland lifted by its fat and never grasped, into a bag whole, and the short right vein into the back of the cava.

Console, cart and wristed arms: how the platform docks, what it changes, and how to undock safely when time matters.