1. In the surgical treatment of invasive bladder cancer,
a thorough lymph node dissection is essential.
2. Patients with testicular cancer without radiographic evidence
of metastasis often harbor microscopic deposits of disease and require
either adjuvant treatment or very close surveillance.
3. Nephrectomy is the mainstay of treatment for localized renal
cell carcinoma, and it also provides a survival benefit in the setting
of metastatic disease.
4. The vast majority of renal trauma can be treated conservatively,
with early surgical intervention reserved for persistent bleeding
or renal vascular injuries.
5. Distal ureteral injuries should only be treated with bladder
reimplantation because of the high failure rate of distal uretero-ureterostomies.
6. Extraperitoneal bladder ruptures can be treated conservatively
but intraperitoneal ruptures typically require surgical repair.
7. Nearly all episodes of acute urinary retention can be treated
with conservative measures such as decreasing narcotic usage and
8. Testicular torsion is an emergency where successful testicular
salvage is inversely related to the delay in repair, so cases with
a high degree of clinical suspicion should not wait for a radiologic
9. Fournier's gangrene is a potentially lethal condition that requires
aggressive débridement and close follow-up due to the frequent
need for repeat débridement.
10. Most small ureteral calculi will pass spontaneously, but larger
stones (>6 mm) are better treated with ureteral stenting and lithotripsy.
The anatomic structures that fall under the purview of genitourinary
surgery are the kidneys, adrenals, ureters, bladder, prostate, seminal
vesicles, urethra, vas deferens, and testes. They are situated mainly
outside the peritoneum, but urologic surgery frequently involves
intraperitoneal approaches to the kidney, bladder, and retroperitoneal
lymph nodes. Furthermore, urologists must be familiar with the techniques
of intestinal surgery for the purposes of urinary diversion and
The kidneys are paired retroperitoneal organs that are invested
in a fibro-fatty layer: Gerota’s fascia. Posterolaterally,
the kidneys are bordered by the quadratus lumborum and posteromedially
by the psoas muscle. Anteriorly they are confined by the posterior
layer of the peritoneum. On the left, the spleen lies superolaterally,
separated from the kidney and Gerota’s fascia by the peritoneum.
On the right, the liver is situated superiorly and anteriorly and
also is separated by the peritoneum. The second portion of the duodenum is
in close proximity to the right renal vessels and, during right
renal surgery, it must be reflected anteromedially (Kocherized)
to achieve vascular control. The renal arteries, in the typical
configuration, are single vessels extending from the aorta that
branch into several segmental arteries before entering the renal
sinus. The right renal artery passes posterior to the vena cava
and is significantly longer than the left renal artery. Occasionally,
the kidney is supplied by a second renal artery, typically to the
lower pole. Within the ...