Common genitourinary surgical procedures in the male population have seen a dramatic rise in frequency as the percentage of men aged greater than 50 years old increases in the United States. Accompanying the advanced age of many men undergoing these procedures is the presence of one or more co-existent medical conditions. This article explores the surgical and anesthetic implications of transurethral resection of the prostate (TURP), radical prostatectomy (RP), transurethral resection of a bladder tumor (TURBT), cystoscopy, and extracorporeal shock wave lithotripsy (ESWL) and the considerations necessary when one or more coexistent illnesses are present. Each procedure will be considered from the surgical, anesthetic, pre-operative and postoperative perspective.