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KEY POINTS

Key Points

  • image Most small ureteral calculi will pass spontaneously or with the use of medical expulsive therapy, but larger stones (>6 mm) are better treated with ureteral stenting or lithotripsy.

  • image Benign prostatic hyperplasia can be managed effectively with medical therapy or minimally invasive endoscopic and robotic surgical techniques depending on the urinary symptoms, patient bother, prostate size, and patient’s therapeutic choice.

  • image Patients with recurrent urethral stricture after endoscopic treatment are unlikely to derive sustained benefit from future endoscopic therapies and should be referred for urethral reconstruction.

  • image The vast majority of renal trauma can be treated conservatively, with early surgical intervention reserved for persistent bleeding, renal vascular, or ureteral injuries.

  • image Extraperitoneal bladder ruptures can be treated conservatively, but intraperitoneal ruptures typically require surgical repair.

  • image 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 diagnosis.

  • image Fournier’s gangrene is a rapidly progressive and potentially lethal condition that requires aggressive débridement and close follow-up due to the frequent need for repeat débridement.

  • image The management of early stage prostate cancer has changed significantly, with a much greater emphasis on risk stratification. Low risk patients are largely treated with active surveillance.

  • image Treatments for urinary incontinence and voiding dysfunction are varied depending on the etiology, severity, and bother of the symptom. Behavior modification, bladder retraining, and medical therapies can all be effective in improving symptoms without the need for surgery.

ANATOMY

The anatomic structures that generally require urologic management include the kidneys, adrenal glands, ureters, bladder, prostate, seminal vesicles, vas deferens, penis, urethra, scrotum, and testes. These organs are located in retroperitoneal or extraperitoneal spaces. However, a transperitoneal approach may be utilized to access the kidney, ureters, bladder, or retroperitoneal lymph nodes during certain urologic operations.

Kidney and Adrenal Gland

The kidneys are paired retroperitoneal organs that are invested in a fibro-fatty layer of tissue known as Gerota’s fascia. This natural barrier helps to tamponade bleeding and thus may provide renal and hemodynamic protection in cases of renal trauma or spontaneous renal hemorrhage. It also may assist in preventing tumor invasion into surrounding structures in the case of large renal masses. The kidneys are bordered posterolaterally by the quadratus lumborum muscle and posteromedially by the psoas muscle. Additionally, the diaphragm drapes across the posterior aspect of the superior pole of each kidney.

The left kidney is bordered anterolaterally by the spleen and descending colon. The pancreatic tail borders the anteromedial left kidney. The right kidney is bordered anterolaterally by the liver and the ascending colon. The second portion of the duodenum may be encountered near the right renal vessels and thus sometimes requires anteromedial reflection, known as the Kocher maneuver, to achieve intraoperative vascular control during right renal surgery.

The kidneys are end organs, which ...

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