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Anesthesiology pp 741-753 | Cite as

Anesthesia for Urological Procedures

  • Hussam Ghabra
  • Susan A. Smith
Chapter

Abstract

Urologic procedures represent a substantial number of surgical cases occurring in both ambulatory surgery centers and inpatient hospitals. A considerable number of urologic surgery patients are elderly and suffer a wide range of comorbidities that require preoperative evaluation and medical optimization. Urologic procedures can be divided into endoscopy (endourologic) and major abdominal surgery. Endourologic procedures represent a sizeable volume of urologic surgery and can generally be performed on an outpatient basis. Common endourologic procedures include cystoscopy for treatment of prostatic enlargement/obstruction or bladder tumors and ureteroscopy for treatment of bladder stones. A wide variety of anesthetic techniques may be used, including monitored anesthesia care (MAC), neuraxial and general anesthesia.

Major urologic procedures include radical prostatectomy, radical or partial nephrectomy, and radical cystectomy. A discussion of the anesthetic concerns related to these procedures includes preoperative evaluation, patient positioning, anesthetic techniques and postoperative pain control. Nephrectomy and cystectomy both carry a substantial risk of blood loss and as a result may require invasive monitors and immediate availability of blood products. Enhanced Recovery After Surgery (ERAS) protocols have widely been accepted in major urologic procedures; elements often included or adapted as part of these urologic care algorithms will additionally be discussed in this chapter

Keywords

Endourologic procedure Transurethral resection of the prostate (TURP) TURP syndrome Radical robotic prostatectomy Nephrectomy Cystectomy Lithotripsy Enhanced recovery after surgery (ERAS) Steep trendelenberg position 

References

  1. 1.
    Bettelli G. Anaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management. Curr Opin Anaesthesiol. 2010;23(6):726–31.CrossRefPubMedGoogle Scholar
  2. 2.
    Hong JY, Yang SC, Ahn S, Kil HK. Preoperative comorbidities and relationship of comorbidities with postoperative complications in patients undergoing transurethral prostate resection. J Urol. 2011;185(4):1374–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.  https://doi.org/10.1016/j.jamcollsurg.2010.01.028.CrossRefPubMedGoogle Scholar
  4. 4.
    Buigues C, Juarros-Folgado P, Fernández-Garrido J, Navarro-Martínez R, Cauli O. Frailty syndrome and pre-operative risk evaluation: a systematic review. Arch Gerontol Geriatr. 2015;61(3):309–21.  https://doi.org/10.1016/j.archger.2015.08.002.CrossRefPubMedGoogle Scholar
  5. 5.
    Michalak MD JR, Lin MD FC, Twiss MD CO. Preoperative evaluation and optimization of the geriatric urologic patient. Urol Pract. 2016.  https://doi.org/10.1016/j.urpr.2016.10.00.
  6. 6.
    Fleisher LA. Evidence-based practice of anesthesiology. Philadelphia, PA: Elsevier/Saunders; 2013.Google Scholar
  7. 7.
    Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia evaluation. Anesthesiology. 2012;116(3):522–38.CrossRefGoogle Scholar
  8. 8.
    Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50(17):1707–32.CrossRefPubMedGoogle Scholar
  9. 9.
  10. 10.
  11. 11.
    Longnecker DE, Newman MF, Mackey S, Sandberg WS, Zapol WM. Chapter 21. Anesthesiology. New York: McGraw-Hill Education; 2017.Google Scholar
  12. 12.
    Vyas KS, Rajendran S, Morrison SD, Shakir A, Mardini S, Lemaine V, Nahabedian MY, Baker SB, Rinker BD, Vasconez HC. Systematic review of liposomal bupivacaine (exparel) for postoperative analgesia. Plast Reconstr Surg. 2016;138(4):748e–56e.  https://doi.org/10.1097/PRS.0000000000002547.CrossRefPubMedGoogle Scholar
  13. 13.
    Mathis MR, Naughton NN, Shanks AM, Freundlich RE, Pannucci CJ, Chu Y, Haus J, Morris M, Kheterpal S. Patient selection for day case-eligible surgery: identifying those at high risk for major complications. Anesthesiology. 2013;119(6):1310–21.  https://doi.org/10.1097/ALN.0000000000000005.CrossRefPubMedGoogle Scholar
  14. 14.
    Butterworth JF, Mackey DC, Wasnick JD, Morgan GE, Mikhail MS. Chapter 31. Morgan & Mikhail's Clinical Anesthesiology. New York: McGraw-Hill; 2013.Google Scholar
  15. 15.
    Gumus E, Kendirci M, Horasanli K, Tanriverdi O, Gidemez G, Miroglu C. Neurapraxic complications in operations performed in the lithotomy position. World J Urol. 2002;20(1):68–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Warner MA, Warner DO, Harper CM, Schroeder DR, Maxson PM. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology. 2000;93(4):938–42.CrossRefPubMedGoogle Scholar
  17. 17.
    Americ an Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Practice advisory for the prevention of perioperative peripheral neuropathies: an updated report by the American Society of Anesthesiologists Task Force on prevention of perioperative peripheral neuropathies. Anesthesiology. 2011;114(4):741–54.CrossRefGoogle Scholar
  18. 18.
    Morgan GE, Mikhail MS, Murray MJ. Anesthesia for genitourinary surgery. In: Clinical anesthesiology. 4th ed. New York: McGraw Hill; 2006. p. 757–72.Google Scholar
  19. 19.
    Pfeffer SD, Halliwill JR, Warner MA. Effects of lithotomy position and external compression on lower leg muscle compartment pressure. Anesthesiology. 2001 Sep;95(3):632–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Simms MS, Terry TR. Well leg compartment syndrome after pelvic and perineal surgery in the lithotomy position. Postgrad Med J. 2005 Aug;81(958):534–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zappa L, Sugarbaker PH. Compartment syndrome of the leg associated with lithotomy position for cytoreductive surgery. J Surg Oncol. 2007;96(7):619–23.CrossRefPubMedGoogle Scholar
  22. 22.
    Stafford-Smith M, Shaw A, Sandler A, Kuhn C. The renal system and anesthesia for urologic surgery. In: Barish PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, editors. Clinical anesthesia. 7th ed. Philadelphia: Wolters Kluwer Health: Lippincott Williams & Wilkins; 2013. p. 1400–39.Google Scholar
  23. 23.
    Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007;178(2):395–401; Epub 2007 Jun 11.CrossRefPubMedGoogle Scholar
  24. 24.
    Chou PS, Chang WC, Chou WP, Liu ME, Lai CL, Liu CK, Ku YC, Tsai SJ, Chou YH, Chang WP. Increased risk of benign prostate hyperplasia in sleep apnea patients: a nationwide population-based study. PLoS One. 2014;9(3):e93081.  https://doi.org/10.1371/journal.pone.0093081.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Roehrborn CG. Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. In: Wein WJ, editor. Campbell-Walsh urology. 11th ed. Philadelphia: Saunders; 2016. p. 2425–62.Google Scholar
  26. 26.
    Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based guidelines (Third Edition). Reg Anesth Pain Med. 2010;35(1):64–101.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Wasson JH, Bubolz TA, Lu-Yao GL, Walker-Corkery E, Hammond CS, Barry MJ. Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997. J Urol. 2000;164(4):1212–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth. 2014;113(5):784–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Tyritzis SI, Stravodimos KG, Vasileiou I, Fotopoulou G, Koritsiadis G, Migdalis V, Michalakis A, Constantinides CA. Spinal versus general anaesthesia in postoperative pain management during transurethral procedures. ISRN Urol. 2011;2011:895874.  https://doi.org/10.5402/2011/895874.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hahn RG. Fluid absorption in endoscopic surgery. Br J Anaesth. 2006;96:8–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Gravenstein D. Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth Analg. 1997;84(2):438–46.CrossRefPubMedGoogle Scholar
  32. 32.
    Hawary A, Mukhtar K, Sinclair A, Pearce I. Transurethral resection of the prostate syndrome: almost gone but not forgotten. J Endourol. 2009;23(12):2013–20.  https://doi.org/10.1089/end.2009.0129.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Aidan M. O’Donnell, Irwin T.H. Foo. Anaesthesia for transurethral resection of the prostate. Contin Educ Anaesth Crit Care Pain (2009) 9(3):92–96. doi: https://doi.org/10.1093/bjaceaccp/mkp012CrossRefGoogle Scholar
  34. 34.
    A K, Kaya S, Turhanoglu S, Ozyilmaz MA. Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. Anaesthesia. 2003;58(6):526–30.CrossRefGoogle Scholar
  35. 35.
    American Society of Anesthesiologists. Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Anesthesiology. 2011;114:247–61.CrossRefGoogle Scholar
  36. 36.
    The American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed 10 Mar 2017.
  37. 37.
    Thiel DD, Winfield HN. Robotics in urology: past, present, and future. J Endourol. 2008;22(4):825–30.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Sooriakumaran P, Srivastava A, Shariat SF, Stricker PD, Ahlering T, Eden CG, Wiklund PN, Sanchez-Salas R, Mottrie A, Lee D, Neal DE, Ghavamian R, Nyirady P, Nilsson A, Carlsson S, Xylinas E, Loidl W, Seitz C, Schramek P, Roehrborn C, Cathelineau X, Skarecky D, Shaw G, Warren A, Delprado WJ, Haynes AM, Steyerberg E, Roobol MJ, Tewari AK. A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol. 2014;66(3):450.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Yaxley JW, Coughlin GD, Chambers SK. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomized controlled phase 3 study. Lancet. 2016;Google Scholar
  40. 40.
    Danic MJ, Chow M, Alexander G, Bhandari A, Menon M, Brown M. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robot Surg. 2007;1(2):119–23.  https://doi.org/10.1007/s11701-007-0024-z.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Open Anesthesia supported by International Anesthesia Research Society. https://www.openanesthesia.org/patient_positioning_and_injury_anesthesia_text/
  42. 42.
    Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;32(5):1389–96.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Wahba RW, Béïque F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth. 1995;42(1):51–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, Rocco PR, Schultz MJ, Pelosi P, Gama de Abreu M. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123(3):692.CrossRefPubMedGoogle Scholar
  45. 45.
    The American Cancer Society. https://www.cancer.org/cancer/kidney-cancer/about/key-statistics.html. Accessed 25 Feb 2017.
  46. 46.
    Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, Saad F, Patard JJ, Montorsi F, Karakiewicz PI. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009;115(7):1465–71.  https://doi.org/10.1002/cncr.24035.CrossRefPubMedGoogle Scholar
  47. 47.
    Go AS, Chertow GM, Fan D, CE MC, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.CrossRefPubMedGoogle Scholar
  48. 48.
    Yokoyama M, Ueda W, Hirakawa M. Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia. Br J Anaesth. 2000;84(6):753–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Conacher D, Soomro NA, Rix D. Anaesthesia for laparoscopic urological surgery. Br J Anaesth. 2004;93(6):859–64.CrossRefPubMedGoogle Scholar
  50. 50.
    Navarro LH, Bloomstone JA, Auler JO Jr, Cannesson M, Rocca GD, Gan TJ, Kinsky M, Magder S, Miller TE, Mythen M, Perel A, Reuter DA, Pinsky MR, Kramer GC. Perioperative fluid therapy: a statement from the group. Perioper Med. 2015;4:3.  https://doi.org/10.1186/s13741-015-0014-z.CrossRefGoogle Scholar
  51. 51.
    American Cancer Society. https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html. Accessed 10 Mar 2017.
  52. 52.
    Shah AD, Abaza R. Clinical pathway for 3-day stay after robot-assisted cystectomy. J Endourol. 2011;25(8):1253–8.  https://doi.org/10.1089/end.2011.0035.CrossRefPubMedGoogle Scholar
  53. 53.
    Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients. A study of doctor-patient rapport. N Engl J Med. 1964;270:825–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Melnyk M, Casey R, Black P, Koupparis A. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5(5):342–8.  https://doi.org/10.5489/cuaj.11002.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Chang SS, Cookson MS, Baumgartner RG, Wells N, Smith JA Jr. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol. 2002;167(5):2012–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Frazier HA, Robertson JE, Paulson DF. Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol. 1992;148(5):1401–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, Djaladat H. Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol. 2014;192(1):50–5.  https://doi.org/10.1016/j.juro.2014.01.097.CrossRefPubMedGoogle Scholar
  58. 58.
    Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.  https://doi.org/10.1016/j.jpain.2015.12.008.CrossRefPubMedGoogle Scholar
  59. 59.
    Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, Skrivanek G, Macaluso A, Shah M, Provost DA. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008;106(6):1741–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Weibel S, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, Eberhart LH, Poepping DM, Afshari A, Kranke P. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth. 2016;116(6):770–83.  https://doi.org/10.1093/bja/aew101.CrossRefPubMedGoogle Scholar
  61. 61.
    Qu G, Cui XL, Liu HJ, Ji ZG, Huang YG. Ultrasound-guided transversus abdominis plane block improves postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries: a randomized controlled double-blinded trial. Chin Med Sci J. 2016;31(3):137–141.59.CrossRefPubMedGoogle Scholar
  62. 62.
    Baack Kukreja JE, Messing EM, Shah JB. Are we doing “better”? The discrepancy between perception and practice of enhanced recovery after cystectomy principles among urologic oncologists. Urol Oncol. 2016;34(3):120.e17–21.  https://doi.org/10.1016/j.urolonc.2015.10.002.CrossRefGoogle Scholar
  63. 63.
    Morales R Jr, Mentz H, Newall G, Patronella C, Masters O. Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty. Aesthet Surg J. 2013;33(8):1148–53.  https://doi.org/10.1177/1090820X13510720.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyOschner Medical CenterNew OrleansUSA

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