Intraoperative Penile Erection Research Articles

Intracavernosal ephedrine for management of intraoperative penile erection during urological procedure under general anesthesia

Intraoperative penile tumescence during urological procedure can occur after regional or general anesthesia. It is a rare event but can cause delay or defer of the surgery. Pathophysiology of intraoperative erection is mainly due to autonomic imbalance during anesthesia. Various physical and pharmacological management of tumescence have been tried with variable success and complication. We injected ephedrine 15 mg intracavernous resulting immediate de-tumescence and minimum complication.

The utility of intravenous ketamine for the management of intraoperative penile erection: a retrospective single-center analysis of endourological surgeries over a 4-year

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.

Safety and Efficacy of Ultra-Low-Dose Intracavernosal Adrenaline for Intraoperative Penile Erection in Transurethral Surgeries under Spinal Anesthesia.

Context:Penile tumescence during endoscopic urological surgeries is a rare but problematic complication that can lead to postponement of the surgery. This study was done to assess the efficacy of ultra-low-dose intracavernosal adrenaline in the management of intraoperative penile erection.Subjects and Methods:Between January 2015 and December 2019, all the patients who developed significant penile tumescence during endourology procedures following regional anesthesia were included. Twenty patients required intervention. They were given half milliliter of solution containing 2.5 μg of adrenaline with insulin syringe. Baseline systolic and diastolic blood pressure, heart rate, and oxygen saturation were noted and were recorded at 1, 2, 3, 4, and 5 min after giving adrenaline. Time to achieve complete detumescence and any other related complications were also noted.Results:Penile detumescence was achieved in 2.6 ± 0.47 min in all the patients. There was an increase in heart rate from baseline value which increased to maximum by 3 min and returned back to baseline by 5 min. Systolic and diastolic blood pressure remained unchanged.Conclusion:All the patients achieved penile detumescence without any significant adverse effects after receiving intracavernosal injection of ultra-low-dose adrenaline.

Intraoperative Priapism during Neuraxial Anaesthesia Resulting in Trouble to the Urologist: A Case Report

Introduction: Priapism following neuraxial anaesthesia for urological endoscopic procedures is uncommon and may result in delay or even postponement of scheduled operations. An imbalance between sympathetic and parasympathetic nervous system usually contributes to intraoperative penile erection, although local stimulation before complete sensory blockade may also lead to priapism. Case Report: We discuss a case of successful management of priapism in 47-year-old Chinese male patient listed for transurethral resection of bladder tumor following a subarachnoid block. Conclusion: With a detailed knowledge about the pathophysiology of intraoperative penile erection, anaesthesiologist can appropriately direct treatment depending on the individual patient and hence minimize the risks of subsequent complications. Keywords: Priapism, spinal anaesthesia, glycopyrrolate, phenylephrine.

Effect of anesthesia on intraoperative penile erection during urologic surgery

Background Intraoperative penile erection is a relatively rare complication during urologic surgery,but it can render the procedure difficult.Although the mechanism of intraoperative penile erection is unclear,anesthetic methods and anesthetics have been shown to affect its occurrence and development.Objective The purpose of this paper is to improve clinicians' understanding for the effects of anesthesia on intraoperative penile erection.Content This review summarizes the mechanism of intraoperative penile erection,possible effects of anesthetic methods and anesthetic drugs on intraoperative penile erection.Trend Applying appropriate anesthetic methods and anesthetics may effectively prevent the occurrence and development of the intraoperative penile erection. Key words: Penile erection; Intraoperative complications; Urologic surgery; Anesthesia; Anesthetics

Intravenous dexmedetomidine for treatment of intraoperative penile erection

Intraoperative penile erections following the initiation of either regional or general anaesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel the planned surgery. The aetiology is unclear. Various treatments proposed for producing detumescence are not always effective. Use of intracavernous alpha-adrenergic agonists is an efficient and rapid but short-lasting treatment. Furthermore, repeated intracavernous injections of vasoactive drugs may be harmful. Dexmedetomidine is a potent, selective α(2)-adrenoreceptor agonist. In our study, we evaluated the effect of dexmedetomidine on intraoperative penile erection. Penile erection developed during an endoscopic procedure in 12 more than 7,800 patients. Anaesthesia used was general in 3 patients, epidural in 1 patient and spinal in 8 patients. The erection rigidity was evaluated by the operating urologist. Dexmedetomidine was diluted in normal saline to a concentration of 4 μg/ml. In all of the cases, 0.5 μg/kg dexmedetomidine was injected intravenously. The incidence of intraoperative penile erection was 0.34% for general anaesthesia, 0.11% spinal anaesthesia and 1.72% epidural anaesthesia at our institution. Detumescence was achieved in 9 patients during the first 5 min and in one patient at the 9th minute after a single intravenous dexmedetomidine (83%). There was no detumescence in two patients after 15 min (17%). This study demonstrated that 0.5 μg/kg intravenous injection of dexmedetomidine is a simple, effective and safe method for immediate relief of intraoperative penile erection with high success rate.

Penile Erection During Transurethral Surgery

Intraoperative penile erection during endoscopic surgery, although an infrequent occurrence, is a troublesome complication and a challenge to the urologist. It is difficult to perform the procedure during penile erection, because various complications may occur. The etiology is unclear, and a number of pharmacological remedies have been discussed in the literature. Herein, we describe the treatment and outcomes for 3 patients with intraoperative penile erection and provide a brief review of the associated literature. Intraoperative penile erection is a rare event during transurethral procedures, with a frequency of approximately 0.1% in our institution. To our knowledge, no generally accepted protocols for the prevention or treatment of this phenomenon have been reported in the literature. We recommend intracorporeal injection of 250 microg of phenylephrine: detumescence occurred rapidly in all patients after a single injection. The mode of administration is simple, and no complications have been reported.

CORTICAL EVOKED POTENTIALS OF THE DORSAL NERVE OF THE CLITORIS AND FEMALE SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS

We evaluated whether disrupting genital central nervous system pathways is associated with subjective reports of sexual dysfunction in women with multiple sclerosis. We performed pudendal somatosensory evoked potential testing in and had sexual questionnaires completed by 14 women with a mean age of 47 years who had multiple sclerosis. The mean expanded disability status score was 5. All but 1 woman reported the desire for sexual intercourse. There was a high rate of dissatisfaction with their sex life and all study participants had concomitant bladder and bowel function problems. The most common sexual complaint was difficult or no orgasm, which was statistically associated with abnormalities or absence of 1 or both pudendal cortical evoked potentials. Fatigue and arousal disorders were also common. Women with multiple sclerosis have a high self-reported rate of sexual dysfunction, which decreases quality of life. Electrodiagnostic data imply that pudendal somatosensory innervation is necessary for normal female orgasmic function. More study is needed to confirm these findings.

Treatment of the Intraoperative Penile Erection with Intracavernous Phenylephrine

A total of 23 patients who had an intraoperative penile erection during endoscopic or penile surgery underwent intracavernous injection of 200 microgram phenylephrine. Detumescence occurred rapidly in all patients with a single injection. Hemodynamic changes consisted of a transient increase in systolic and diastolic blood pressures (+9 percent, p less than 0.05) without significant change in pulse rate (-5 percent, p greater than 0.05). No marked side effect was reported even in elderly patients. Intraoperative penile erection, which seems to be more frequent in patients younger than 50 years, during general anesthesia with propofol or epidural anesthesia, can be treated safely with intracavernous injection of phenylephrine.

Treatment of the Intraoperative Penile Erection with Intracavernous Phenylephrine

Treatment of the Intraoperative Penile Erection with Intracavernous Phenylephrine

Dorsal Nerve Block for Management of Intraoperative Penile Erection

Intraoperative penile erection during general anesthesia can delay or prevent the completion of cystoscopic or penile surgical procedures. The dorsal penile nerve block is offered as a treatment for intraoperative erection. Advantages of this technique include less potential for cardiovascular complications and improved postoperative analgesia.

Treatment of Pharmacological Priapism with Phenylephrine

Pharmacological prolonged erections or priapism due to anesthesia were treated in 36 patients with intracorporeal injections of phenylephrine. Detumescence was obtained rapidly in every case and no marked side effect was reported. Considering the possible toxicity of other adrenergic agents, phenylephrine is strongly recommended in the treatment of priapism.

Metaraminol resolves intraoperative penile erection

Metaraminol resolves intraoperative penile erection

Intracavernosal metaraminol for treatment of intraoperative penile erection

Four patients developed penile erection when regional anaesthesia was induced with spinal block. In another patient, penile erection developed during fentanyl-induced general anaesthesia. Injection of metaraminol into corpus cavernosum successfully achieved detumescence in all these patients. The dose of metaraminol ranged from 10 to 25 micrograms, much less than that required for the treatment of vasodilator-induced priapism. Intracavernosal injection of metaraminol is a simple, effective and safe method for immediate relief of intraoperative penile erection. It is most useful when urogenital operation would be delayed by penile tumescence.