Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 60. Anesthetic Considerations for Genitourinary and Renal Surgery Maurizio Cereda, MD, and Sean Kennedy, MD

Key Points

"1. Patient positioning is important in urologic surgery because of the variety and complexity of the positions used. Knowledge of the physiologic implications and the possible complications of these positions is critical to preventing untoward outcomes.

2. For most endourologic procedures, rapid anesthetic onset and recovery are desired. These goals can be reached with either general or neuraxial anesthesia, provided appropriate pharmacologic choices are made.

3. Use of neuraxial anesthesia for transurethral resection of the prostate (TURP) does not have proven outcome benefits over general anesthesia, but it may facilitate the detection of TURP syndrome. This is the most severe complication of TURP, although its frequency has decreased with the use of current irrigation fluids.

4. For extracorporeal shock wave lithotripsy, intravenous sedation can be effective when lower intensity waves are used. Intrathecal narcotics seem to be a valid alternative.

5. Epidural analgesia may offer some advantages when added to general anesthesia for radical prostatectomy and cystectomy, but no outcome benefits have yet been demonstrated.

6. Blood loss is a significant concern in urologic cancer procedures such as prostatectomy, cystectomy, nephrectomy, and lymph node dissections. A variety of techniques..."