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Positioning for Urological Procedures

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Anesthesia for Urologic Surgery

Abstract

Urological procedures, either open or endoscopic, usually require strategic positioning to allow surgical access to the pelvis, retroperitoneum, and the perineum. Anesthesiologists, urologists, and nurses have a shared responsibility to ensure patient safety while providing optimal surgical exposure. Knowledge of the physiologic changes associated with the various positions is of utmost concern in the care of these patients. Heed should be taken during patient positioning to avoid iatrogenic injuries, including ocular injury, compartment syndrome, and peripheral nerve damage. Improper positioning may cause complications, though rare, that are not only physically and emotionally devastating but may also have medicolegal consequences.

Nerve injuries comprise 22 % of all anesthesia-related medicolegal claims in the United States (Best Pract Res Clin Anaesthesiol 25:263–76, 2011), and according to the American Society of Anesthesiologists Closed Claims Project, since 1990, 10 nerve injuries (7 %) of the 143 urologic claims reviewed were directly related to patient positioning. Four of these claims resulted in a median award of $49,000 (Urology 76:1309–16, 2010). Additionally, Welch et al. retrospectively reviewed 380,680 cases over a 10-year period at a single institution and reported 112 cases of perioperative nerve injuries. Urological procedures accounted for 15 % of the reviewed cases and 13 % of the peripheral nerve injuries (Anesthesiology 111:490–7, 2009).

Ocular injuries range from the relatively common (and minor) corneal abrasion which can happen in any position to the rare, devastating complication of ischemic optic neuropathy that can occur with the use of the prone or Trendelenburg positions (Anesthesiology 105:652–9, 2006; J Neuroophthalmol 27:285–7, 2007). Compartment syndrome, another devastating complication, has been reported to occur with the use of several positions after prolonged urologic surgery (BJU Int 104:577–8, 2009).

This chapter discusses the various patient positions used for urologic procedures, physiologic changes, potential injuries, and the management of position-related complications.

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Authors and Affiliations

  1. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY, 10029, USA

    Jonathan Gal M.D. & Jaime Hyman M.D.

  2. Departments of Anesthesiology and Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY, 10029, USA

    Daniel M. Gainsburg M.D., M.S.

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  1. Jonathan Gal M.D.
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  2. Jaime Hyman M.D.
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  3. Daniel M. Gainsburg M.D., M.S.
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Correspondence to Daniel M. Gainsburg M.D., M.S. .

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Editors and Affiliations

  1. Departments of Anesthesiology and Urolog, Icahn School of Medcine at Mount Sinai, New York, New York, USA

    Daniel M. Gainsburg

  2. The Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai Department of Anesthesiology, New York, New York, USA

    Ethan O. Bryson

  3. The Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai Department of Anesthesiology, New York, New York, USA

    Elizabeth A. M. Frost

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Gal, J., Hyman, J., Gainsburg, D.M. (2014). Positioning for Urological Procedures. In: Gainsburg, D., Bryson, E., Frost, E. (eds) Anesthesia for Urologic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7363-3_12

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