Renal cell carcinoma (RCC) is the seventh most common cancer in men and the ninth most common in women. RCC is approximately 50% more common in men than in women. Associated risk factors include tobacco use, obesity, hypertension, occupational exposures, polycystic kidney disease, chronic hepatitis C infection, long-term analgesic use, and genetics. RCCs are classified according to cell type and extent of metastasis, with clear cell tumors being more common and carrying a better prognosis than granular cell or spindle tumors. Clinical manifestations include hematuria, flank pain, and in the some cases, a palpable mass in the abdomen or flank. Treatment includes surgical removal (open radical nephrectomy vs. laparoscopy), radiofrequency ablation, and/or chemotherapy/radiation therapy.

Prostate cancer is the second most common malignancy among men. Prostate cancer occurs more often in African American men than in men of other races. Risk factors include genetics, first-degree relatives with prostate cancer, tobacco use, and high-fat diet. More than 95% of prostate neoplasms are adenocarcinomas, and clinical manifestations include bladder outlet obstruction (different from symptoms of BPH in that symptoms do not remit) and rectal obstruction. Bone pain is often associated with advanced disease. Treatment considerations include the stage of the cancer, life expectancy, general health of the individual, age, and anticipated effects of treatment. Surgical options include radical prostatectomy (with either a retropubic or perineal approach), transurethral resection of the prostate (TURP), cryosurgery, or laparoscopy (done manually or via robotic approach). Other options include chemotherapy, radiation therapy, hormone therapy, or no treatment.

Bladder cancer is the fourth most common malignancy among men and is 3 times more common in men than in women. Although bladder cancer is considered a disease of the elderly, the disease is more prevalent in Caucasians than in African Americans and Hispanics. Associated risk factors include tobacco use, pelvic irradiation, and exposure to cyclophosphamide, aromatic amines, diesel exhaust, and chemicals used in aluminum, rubber, or leather making industries. Although nonpapillary tumors tend to be less common, they are more invasive and carry worse prognoses when compared to papillary tumors. Although certain individuals may be asymptomatic, a common clinical manifestation includes painless hematuria. Treatment options
include transurethral resection of the bladder tumor or laser treatment with neodymium:yttrium aluminum garnet for superficial tumors, intravesicular BCG or interferon for carcinoma in situ, or cystectomy for invasive bladder cancer and/or chemotherapy/radiation therapy.

Across both genders, Caucasians have the highest prevalence of nephrolithiasis, with males 2 to 3 times more affected than females. Calcium-containing stones are the most common stone type and account for 70% to 90%, followed by uric acid, struvite, cystine, and xanthine stones. The larger the stone type, the more invasive the procedure. Percutaneous nephrolithotomy is often reserved for stones greater than 1.5 to 2.0 cm because shock wave lithotripsy and ureteroscopy may not be as effective for larger stones. Indications for immediate urologic evaluation and/or hospitalization include obstruction (especially in individuals with solitary kidney or transplanted kidney), urosepsis, intractable pain, and/or acute renal failure.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, BPH affects about 50% of men between the ages of 51 and 60 and up to 90% of men older than 80. Clinical manifestations include increased hesitancy and straining, weak urine stream, dribbling, incomplete bladder emptying, increased urgency, dysuria, nocturia, and/or frequent urination. Treatment options for BPH include surveillance, medical therapy, minimally invasive therapies, or surgery. TURP is the most common procedure performed to treat BPH with significant lower urinary tract symptoms. Other transurethral procedures such as ablation, laster enucleaton, and photoseclective vaporization are also available. This chapter mainly focuses on postoperative management after TURP.

Patients presenting for urologic procedures are often elderly and have comorbid medical conditions including preexisting cardiopulmonary disease and renal impairment. This must be taken into account when evaluating and caring for this patient population.