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  • Image not available.The lithotomy position is the most commonly used position for patients undergoing urological and gynecological procedures. Failure to properly position patients can result in iatrogenic injuries.
  • Image not available.The lithotomy position is associated with major physiological alterations. Functional residual capacity decreases, predisposing patients to atelectasis and hypoxia. Elevation of the legs increases venous return acutely. Mean blood pressure often increases, but cardiac output does not change significantly. Conversely, rapid lowering of the legs acutely decreases venous return and can result in hypotension. Blood pressure measurements should always be taken immediately after the legs are lowered.
  • Image not available.Because of the short duration (15–20 min) and the outpatient setting of most cystoscopies, general anesthesia is usually used.
  • Image not available.Both epidural and spinal blocks can provide satisfactory anesthesia. A sensory level to T10 provides excellent anesthesia for nearly all cystoscopic procedures.
  • Image not available.Manifestations of the TURP (transurethral resection of the prostate) syndrome are primarily those of circulatory fluid overload, water intoxication, and, occasionally, toxicity from the solute in the irrigating fluid.
  • Image not available.Absorption of irrigation fluid appears to be dependent on the duration of the resection as well as the height (pressure) of the irrigation fluid.
  • Image not available.When compared with general anesthesia, regional anesthesia appears to reduce the incidence of postoperative venous thrombosis; it is also less likely to mask symptoms and signs of the TURP syndrome or bladder perforation.
  • Image not available.Patients with a history of cardiac arrhythmias and those with a pacemaker or internal cardiac defibrillator (ICD) may be at risk for developing arrhythmias induced by shock waves during extracorporeal shock wave lithotripsy (ESWL). Shock waves can damage the internal components of pacemaker and ICD devices.
  • Image not available.Patients who are undergoing retroperitoneal lymph node dissection and who are receiving bleomycin preoperatively are at increased risk for developing postoperative pulmonary insufficiency. These patients appear to be particularly sensitive to oxygen toxicity and fluid overload, and are at increased risk for developing acute respiratory distress syndrome postoperatively. Excessive intravenous fluid administration may also be contributory.
  • Image not available.The serum potassium concentration should be below 5.5 mEq/L and existing coagulopathies should be corrected in patients undergoing renal transplantation. Hyperkalemia has been reported after release of the vascular clamp following completion of the arterial anastomosis, particularly in small patients and pediatric patients. Release of potassium contained in the preservative solution has been implicated in those cases.

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Urological procedures account for 10–20% of most anesthetic practices. Patients undergoing genitourinary procedures may be of any age, but most are elderly and many have coexisting medical illnesses, particularly renal dysfunction. Anesthetic management of patients with renal impairment is discussed in Chapter 32, and the effects of anesthesia on renal function are discussed in Chapter 31. This chapter reviews the anesthetic management of common urological procedures. Use of the lithotomy position, the transurethral approach, and extracorporeal shock waves (lithotripsy) complicates many of these procedures. Moreover, advances in surgical technique allow more patients to undergo radical procedures for urological cancer, urinary diversion with bladder reconstruction, and renal transplantation.

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Cystoscopy

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