Includes Index

Urology is a surgical subspecialty involving the medical and surgical management
of disorders of the urinary tract, specifically the kidneys, ureters, and bladder in
men, women, and children in addition to the male urogenital tract, prostate, urethra, penis, and testes. Surgical procedures have become a mainstay for the diagnosis and management of many of the associated urologic disorders. Urologists have
embraced the use of new technologies to maintain their role both in caring for these
disorders and in pioneering the use of minimally invasive procedures for their
patients. A generation ago, renal stones were managed via a flank incision with an
associated hospital stay and at-home recuperation; these procedures are now performed for the most part in the ambulatory setting and in many cases without any
instrumentation, instead by delivering stone-breaking shock waves through the
skin to achieve the same result as open surgery. Likewise, urology has embraced
laparoscopy and most recently robotic-assisted laparoscopy to replace open surgery to treat numerous disorders, converting what would be a painful and lengthy
hospital stay into significantly shorter time in the hospital, with less pain, and in
the case of prostatectomy, a bloodless procedure. As the use of technology has
expanded in urology, so has the spectrum of patients undergoing surgery, with
robotics used to repair obstructions in children and in older patients requiring more
complicated procedural interventions.
Critical to these transitions in urological care has been, and continues to be, the
evolution of anesthesia. The majority of procedural urology is now performed in the
ambulatory setting, often in an office, which alters the type and delivery of anesthesia. Prolonged CO2 insufflation during laparoscopic and robotic cases also requires
particular care to avoid specific complications in addition to particular concerns for
complications of unique patient positioning. Furthermore, these considerations
must be approached in the youngest and oldest of patients. This book aims to cover
the particular concerns of urological anesthesia, highlighting the team approach between the anesthesiologist and the surgeon as necessary to maintain the positive
outcomes of the advances in patient care.