KEY POINTS1. 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. 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 ureteroureterostomies.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 uand increasing ambulation.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 diagnosis.9. Fournier's Gangrene is a potentially lethal condition that requires aggressive dbridement and close follow-up due to frequent need for repeat dbridement.10. Most small ureteral calculi will pass spontaneously, but Larger Stones (>6 Mm) are better treated with ureteral stenting and lithotripsy.

ANATOMY anatomic structures that fall under the purview of genitourinary surgery area) Kidneysb) Adrenalsc) Uretersd) Bladdere) Prostatef) Seminal Vesiclesg) Urethrah) Vas Deferensi) Testes situated mainly outside the peritoneum Urologic surgery frequently involves intraperitoneal approaches to the kidney, bladder, and retroperitoneal lymph nodes.

Kidney and AdrenalKidneys Paired retroperitoneal organs Invested in a fibro-fatty layer: Gerota's fascia. Posterolaterally, the bordered by the quadratus lumborum Posteromedially by the psoas muscle Anteriorly they are confined by the posterior layer of the peritoneum. On the left, the spleen lays 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. Second portion of the duodenum is in close proximity to the right renal vessels During right renal surgery, it must be reflected anteromedially (Kocherized) to achieve vascular control Renal arteries are single vessels extending from the aorta that branch into several segmental arteries before entering the renal sinusa) RIGHT RENAL ARTERY passes posterior to the Vena Cava significantly longer than the left renal artery Occasionally, the kidney is supplied by a second renal artery, typically to the lower pole. Within the kidney, there is essentially no anastomotic arterial flow, so the kidneys are prone to infarction when branch vessels are interrupted Renal Veins, which course anteriorly to the renal arteries, drain to the Vena Cava Left Renal Vein passes anteriorly to the aorta much longer than the right renal vein is in continuity with the left Gonadal Vein, the Left Inferior Adrenal Vein, and a Lumbar Vein provide adequate drainage for the left kidney in the event that drainage to the vena cava is interrupted Right Renal Vein has no such collateral venous drainage. Collecting system of the kidney is composed of several major and minor calyces that coalesce into the renal pelvis. Renal Pelvis can have either a mainly intrarenal or extrarenal position Tapers into the ureteropelvic junction (UPJ) where it joins with the ureter.

Adrenal Glands Lie superomedially to the kidneys within Gerota's fascia. There is a layer of Gerota's fascia between the adrenal and the kidney In the presence of a tumor or inflammatory process, the adrenal can become very adherent to the kidney, and separation can be difficult Arterial supply of the adrenals derives from the aorta and small branches from the Renal Arteries Venous drainage on the left is mainly through the Inferior Phrenic Vein and through the Left Renal Vein via the Inferior Adrenal Vein On the right, the adrenal is drained by a very short (20) is much more likely to have spread Often at a micrometastatic level After definitive treatment, an increasing PSA is indicative of recurrent cancer. Most common site of spread: pelvic lymph nodes and bone Patients with intermediate or high-risk disease based on clinical stage, grade on biopsy, and PSA level, staging includes bone scan and CT imaging to evaluate the pelvic lymph nodes. Multiple treatment options are available for men with localized disease, including Radical prostatectomy (retropubic, perineal, or robotic/laparoscopic approaches) Brachytherapy External Beam Radiation Therapy. For low-risk disease, the efficacy of each treatment modality is thought to be similar Radical Prostatectomy can be performed with Unilateral or Bilateral Cavernosal Nerve-Sparing to limit postoperative erectile dysfunction (ED). For high-risk disease Either NonNerve-Sparing Surgery or External Beam Radiation Therapy plus Androgen Deprivation may be performed Irritative voiding and bowel symptoms are common after radiation therapy, with ED being a late side effect. Radical prostatectomy is associated with early incontinence and ED (depending on nerve-sparing). Incontinence improves significantly with time, with