Anesthesia for Urological Surgery

Abstract

In this chapter we discuss the urinary system anatomy and physiology pertinent to anesthesia cases. Additionally, the anesthetic management of common urologic procedures and associated complications are reviewed. Recognizing the spinal pain segments relevant to the genitourinary system is important for planning of spinal and epidural anesthesia. Urologic surgery also has a number of patient positioning considerations that are reviewed including the implications of placing patients in lithotomy position or the lateral decubitus position. During surgery, it is critical for the anesthesiologist to avoid nephrotoxic drugs, correct hypovolemia, dose drugs based on renal function, and monitor for causes of urinary outflow tract obstruction. Finally, common urologic procedures are reviewed including cystoscopy, ureteroscopy, transuretheral resection of the prostate, laser urologic surgery, radical prostatectomy, radical cystectomy, nephrectomy, renal transplantation, orchiectomy, orchidopexy, and penile surgery. Additionally, anesthestic considerations for extracorporeal shock wave lithotripsy (a minimally invasive technique used for the treatment of renal calculi and ureteral stones) are provided. The chapter conclused with a discussion of complications unique to urological surgery including ladder peroforation, autonomic hyperreflexia and TURP syndrome.

For maximum impact, it is recommended that the case study and questions found on page xxviii are reviewed before reading this chapter.