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Traumatic injuries to the genitourinary tract are seen in 2.2%–10.3% of patients admitted to emergency units ( Brandes et al. 1995 ; Marekovic et al. 1997 ; Salvatierra et al. 1969 ; Tucak et al. 1995 ; Archbold et al. 1981 ). Of these injuries, between one-third and two-thirds are associated with injuries to the external genitalia ( Brandes et al. 1995 ). Due to anatomy and prevalence of accidents, men have a higher incidence of genital trauma than women, since men have an increased exposure to violence, performance of aggressive sports and motor vehicle accidents. In addition, a worldwide increase in domestic violence has led to rising numbers of gunshot and stab wounds over the last few years ( Tiguert et al. 2000 ; Cline et al. 1998 ; Jolly et al. 1994 ; Bertini and Corriere 1988 ), with as many as 35%of all gunshot wounds affecting also the external genitalia (Monga and Hellstrom 1996).

When one reviews the literature surrounding penile amputation, most of what is found is individual case reports or reports of small series. Thus what is considered to be state-of-the-art management is gleaned from literature review, and frankly reliant on expert opinion. An exception to this statement is a series of penile amputation from Thailand published in 1983 ( Bhanganada et al. 1983 ) in the American Journal of Surgery . That report described the management of approximately 100 cases of penile amputation, many of which preceded the description of microreplantation techniques and validated much of what literature reviews have proposed.

Themale urethra is divided into the anterior and posterior sections by the urogenital diaphragm. The posterior urethra consists of the prostatic and the membranous urethra (Fig. 15.9.1). The anterior urethra consists of the bulbar and penile urethra. Only the posterior urethra exists in the female; the anterior urethra corresponds to the labia minora, which results from persistent separation of the urethral folds on the ventral surfaces of the genital tubercle.

Priapism is defined as an erection lasting longer than 4 h that is not associated with sexual stimulation. It is generally classified into two etiologies: ischemic and nonischemic. The former, comprising the vast majority of cases, is considered an emergency due to the associated pain as well as to structural changes in the penis that may lead to penile fibrosis and severe erectile dysfunction. Conservative management is rarely effective except in select circumstances. Interventions may include aspiration of the corpora, injection of vasoconstrictive agents, or surgical procedures. Nonischemic priapism presents fewer emergent risks andmay be followed conservatively. If intervention is necessary, angiographic embolization is often the best therapeutic option.

Attention to surgical details and a commitment to surgical excellence are two fundamental principles that will help provide the best clinical and functional results following open surgical procedures. Most postoperative complications can be clinically related or traced back to technical errors made in the operating room. Thus, the importance of avoiding or reducing intraoperative surgical complications cannot be overemphasized.

The first nephroscope for percutaneous renal access was introduced 1981 by Marberger et al. (1981, 1982). Since that time, percutaneous nephrolithotomy (PCNL) has evolved as a standard procedure in kidney stone therapy. In this chapter, we will focus on the complications of this procedure.

Since the introduction of the transurethral resection of the prostate (TURP) by McCarthy in 1926, instruments, accessories, and surgical technique have changed as a result of improved experience and understanding of pathophysiology, prevention, and treatment of the complications of both TURP and TURB (transurethral resection of bladder tumors). Nevertheless, complications still exist, causing the community of transurethral surgeons to continue to seek innovative techniques and possibilities to secure the instrumental treatment of the lower urinary tract syndrome (LUTS) due to benign prostatic hyperplasia (BPH) and bladder tumors. Borborgoglu et al. recently compared their data on complications following TURP between 1991 and 1998 with earlier published data from the 1980s ( Borboroglu et al. 1999 ; Mebust et al. 1989 ; Horninger et al. 1996 ). Their results provide a good overview of the complications to be expected and state that due to recent improvements in how high-frequency current is applied, TURP-related complications significantly decreased in the last decade. The complications are classified in intraoperative and early and late postoperative complications (Tables 17.3.1, 17.3.2).

In the last decade, the popularity of laparoscopic surgery has exploded, as evidenced by the dramatic increase in the number of laparoscopically performed urologic procedures. This has been driven by the potential of laparoscopic surgery to achieve the same goals as a standard open approach while offering the patient distinct advantages with regard to perioperative morbidity, length of hospital stay, and convalescence. However, there are also disadvantages to the endoscopic approach. Typically the learning curves for laparoscopic operations are long and there are a number of pitfalls that potentially complicate these procedures. Even for very experienced open surgeons, it is difficult to translate skills and knowledge directly to the endoscopic technique.

Historically, major bleeding was a significant problem associated with radical retropubic prostatectomy and cystectomy, TUR, and nephrectomy. Nowadays, major life-threatening hemorrhage after urologic open and endoscopic surgery by expert surgeons is a rare event. In some cases, the patient typically becomes hemody-namically unstable soon after arrival in the recovery room. On the other hand, sometimes hemorrhage arises a few hours or days following the initial procedure. The surgeon must make a decision whether to return immediately to the operating room or treat the patient conservatively with blood and volume replacement ( Kaufman and Lepor 2005 ). Reasons for a significant major bleeding later on in the postoperative period may be slipped ligatures or clips (e.g., from the renal pedicle or other major blood vessels) or in case of partial nephrectomy, ruptured kidney. Also, removal of drains days after surgery may induce significant bleeding, if the drains have been put primarily through a major blood vessel (e.g., epigastric). Reasons for early revisions may be insufficient ligatures or hemostasis.

This chapter reviews our approach to preventing and managing infectious emergencies complicating urological surgery from our perspective as practicing urologists. We focus on the surgical site and urinary tract infections that are of most interest to practicing urologists. Because of limited space, we omitted important postoperative problems that are less relevant to urological practice, such as respiratory infections and antibiotic- associated bowel problems. When appropriate, we highlight studies of special interest and outline our own clinical approach to management of urological patients with postoperative infectious complications.