KEY POINTS

1. Innervation of the intra-abdominal components of the genitourinary system, namely, the kidney and the ureter, is primarily thoracolumbar (T8-L2). The nerve supply of the pelvic organs, namely, the bladder, prostate, the seminal vesicles, and the urethra, is primarily lumbosacral with some lower thoracic input.
2. The spinal level of pain conduction for the external genitourinary organs is S2-4, with the exception of the testes (T10-L1).
3. The kidneys receive 15% to 25% of the total cardiac output, most of this blood being directed to the renal cortex. Renal medullary papillae are therefore more vulnerable to ischemic insults. Kidneys successfully autoregulate their blood flow between 60 and 160 mm Hg mean arterial pressures.
4. The GFR is the best measure of glomerular function. Creatinine clearance is a good measure of the GFR; urine output is not.
5. Hypervolemia, acidemia, hyperkalemia, cardiorespiratory dysfunction, anemia, and bleeding disturbances are manifestations of chronic renal failure.
6. Although renal transplantation reverses most of the abnormalities in end-stage renal disease, dialysis improves only some and introduces additional complications of its own.
7. Even though newer techniques such as laser prostatectomy are gaining ground, TURP remains the gold standard. TURP syndrome is a constellation of symptoms caused by the absorption of hypotonic bladder irrigants. Cardiovascular and neurologic changes are due to hypo-osmolality, hyponatremia, hyperglycinemia, hyperammonemia, and hypervolemia.
8. Regional anesthesia offers several advantages over general anesthesia for TURP, although 30-day mortality rates remain unchanged at 0.2% to 0.8%.
9. Laparoscopic surgery in urology frequently requires insufflation of CO₂ into the retroperitoneal space. In lengthy procedures, pneumomediastinum and subcutaneous emphysema of the head and neck may occur.
10. ESWL is associated with significant physiologic changes related to immersion if a water bath is used. Shock waves can cause arrhythmias and injury to the lungs. Pregnancy and untreated bleeding disorders are contraindications to ESWL.
11. Five percent to 10% of renal tumors extend into the renal vein, inferior vena cava, and right atrium. Complications ranging from circulatory failure to embolization of tumor during surgery may occur. Cardiopulmonary bypass may be necessary for surgery.
12. Radical prostatectomy is accompanied by significant blood loss. Intraoperative venous air embolism has been reported. Regional anesthesia with spontaneous ventilation is associated with less blood loss than general anesthesia and intermittent positive-pressure ventilation are. Other advantages of epidural anesthesia include decreased deep vein thrombosis and preemptive analgesia. Although some studies report better outcomes with epidural anesthesia, others do not.