Chapter 34 - Anaesthesia for Urological Surgery in Children

Summary

Anaesthesia for paediatric urology may be for minor to major complex surgery. In this chapter, we discuss the anaesthetic management of a subspecialty that allows for a variety of general and regional anaesthetic techniques to be applied. Minor procedures include cystoscopy, resection of posterior urethral valves, circumcision, insertion of suprapubic (SP) lines, hypospadias repair and orchidopexy. We discuss techniques for major surgery, including pyeloplasty, ureteric re-implantation, nephrectomy, resection of Wilms tumour (nephroblastoma), bladder exstrophy and epispadias repair, bladder augmentation (ileocystoplasty) and formation of Mitrofanoff, as well as renal transplantation. Preoperatively, children undergoing cystoscopy and major urological and reconstructive surgery require a urine culture to guide antibiotic prophylaxis. Local ‘maximum surgical blood ordering schedules’ should be followed for guidance regarding cross-matching of blood for major procedures. Close communication with the surgeon and wider multidisciplinary team is necessary to identify the extent of surgery, positioning and appropriate vascular access for complex surgery and renal transplantation.