Anesthesia for Genitourinary Surgery in the Neonate

Abstract

Congenital anomalies of the kidney and urinary tract constitute 20-30% of all prenatal anomalies. Congenital renal tumors are rare (7% of all tumors in neonates), and prenatal ultrasonography can detect about 15% of them. They are often benign and present later during infancy. Congenital anomalies of external genitalia occur in 1:125 live male births with isolated hypospadias in 0.8% of newborns and isolated cryptorchidism in 5% term and 15% premature newborns. Severe hypospadias or nonpalpable testes are associated with differences of sex development (DSD). Micropenis may be associated with insufficient testosterone secretion during third trimester. The most common disorder of the gonads is congenital inguinal hernia, with an incidence of 3-5% in term and up to 30% in preterm neonates, more in male babies. Major urogenital procedures are usually not undertaken during the highly vulnerable neonatal period. Procedures usually performed are those that cause urinary obstruction or associated with failed gonadal descent, and large congenital inguinal hernias. It is important to do a thorough preoperative evaluation to rule out other congenital anomalies and associated syndromes. Most urogenital surgeries require baby to be placed in lithotomy position, and care must be taken to avoid nerve injuries. Other important concerns include prevention of hypothermia (secondary to irrigation fluid used), and during laparoscopic surgery, prevention of urinary infections and bacteremia (in obstructive uropathies), and latex allergy (multiple surgical procedures and exposure to latex gloves).