Abstract
BackgroundTo assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition.MethodsOf 402 endoscopic urological procedures performed in our clinic over a 4-year (2015–2019) period, a total of 9 cases with intraoperative penile erection impeding instrumentation during endourological surgery were included. Data on patient age, weight, height, American Society of Anesthesiologists (ASA) physical status classification system scores, type and duration of surgery, type and level of anesthesia, onset of erection, treatment characteristics and treatment outcome were recorded for each patient.ResultsThe mean (SD) age was 68.3 years (range, 66.0–77.0 years). ASA physical status category I and II were noted in 55.6 and 44.4% of patients, respectively. All cases received spinal anesthesia (n = 9) at T8–10 dermatome levels, for TURP in 7 (77.8%) cases and for TURBT in 2 (22.2%) cases. The onset of penile erection was post-urethroscope in 7 (77.8%) cases. The average total ketamine dose was 34.3 mg (range, 18.0–75.0 mg). The average duration of the operation was 91.7 min (range, 40.0–140.0 min). Ketamine treatment resulted in resolved erection with delayed procedure in 7 (77.8%) cases, while conversion to general anesthesia was required in 2 (22.5%) cases.ConclusionsIn conclusion, the prevalence of intraoperative penile erection during spinal anesthesia for endourological surgery was 2.2% in our experience. These findings demonstrated that intravenous injection of ketamine is an effective and safe method for immediate resolution of intraoperative penile erection with a high success rate.
Highlights
To assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition
Study population Of 402 endoscopic urological procedures performed in our clinic over a 4-year (2015–2019) period, a total of 9 cases with intraoperative penile erection development impeding instrumentation during endourological surgery were included in this retrospective study
All cases received spinal anesthesia (n = 9) at T8–10 dermatome levels, for Transurethral resection of prostate (TURP) in 7 (77.8%) cases and for Transurethral resection of bladder tumor (TURBT) in 2 (22.2%) cases
Summary
To assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition. Penile tumescence resulting in partial or total erection under anesthesia at the time of endoscopic urological surgery is a relatively infrequent but challenging condition with reported incidence of 0.1 to 2.4% [1–4]. Many pharmacological treatments to produce detumescence have been proposed, such as intracavernous injection of ephedrine, phenylephrine, metaraminol, noradrenaline and adrenaline [4, 7–10] or intravenous injection of ketamine [6, 11–13], dexmedetomidine [5], terbutaline [14] and glycopyrrolate [15]. The aim of this paper was to present the prevalence of intraoperative penile erection in our endourological surgery practice and the utility of intravenous ketamine in the management of the condition Many pharmacological treatments to produce detumescence have been proposed, such as intracavernous injection of ephedrine, phenylephrine, metaraminol, noradrenaline and adrenaline [4, 7–10] or intravenous injection of ketamine [6, 11–13], dexmedetomidine [5], terbutaline [14] and glycopyrrolate [15]. (2020) 20:4
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
