Intracavernous Injection of Noradrenaline to Interrupt Erections
during Surgical Interventions

Meyer, J; Sy, W. A. De

doi:10.1159/000472608

Cited by 21 publications

(8 citation statements)

References 3 publications

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“…Moloney et al (1975) found that epidural anesthesia combined with chlorpromazine‐induced hypotension results in transient penile flaccidity only at a systolic blood pressure equal to or less than 70 mm Hg; this technique is not indicated for the increased venous drainage. de Meyer and de Sy (1986) recommended intracavernous injection of noradrenaline to interrupt erections during transurethral procedures. Shantha (1989) has recommended the use of terbutaline (5 mg orally or 0.25–0.5 mg subcutaneously or intravenously) for the treatment of intraoperative penile erection.…”

Section: Discussionmentioning

confidence: 99%

Penile Erection During Transurethral Surgery

Baltogiannis

Charalabopoulos

Giannakopoulos

et al. 2006

Journal of Andrology

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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 mg of phenylephrine: detumescence occurred rapidly in all patients after a single injection. The mode of administration is simple, and no complications have been reported.Key words: Endoscopy, alpha-adrenergic agonists, phenylephrine, priapism.J Androl 2006;27:376-380 S ome degree of penile engorgement following epidural anesthesia is not uncommon because of vasodilatation and pooling of blood in the venous sinuses of the penis. However, penile tumescence resulting in partial or total erection at the time of cystoscopy or transurethral surgery is a relatively infrequent phenomenon (Walther et al, 1987). It is very troublesome to perform the procedure during penile erection because attempts to do so will lead to complications, such as excessive bleeding and urethral trauma, and surgery has to be delayed or postponed as a result. At our institution, during the last 16 years (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004), of 2867 patients who received epidural anesthesia while undergoing different transurethral procedures, such as transurethral resection of the prostate (TUR-P), transurethral resection of bladder tumors, transurethral incision of the prostate, or optical internal urethrotomy, intraoperative penile erection was only encountered in 3. The management of these cases, along with a review of the literature, is presented. Materials and MethodsOver a 16-year period (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) at our institution, only 3 (approximately 0.1%) of 2867 patients had a penile erection while undergoing an endoscopic surgery procedure with epidural anesthesia. All 3 were successfully treated with an intracorporeal injection of 250 mg phenylephrine. Patient 1A 58-year-old man was admitted for transurethral resection of multiple superficial bladder carcinomas. He had a history of atrial fibrillation that was controlled with administration of digoxin. Results of routine laboratory analyses, including routine blood tests, prothrombin time, platelet count, fibrinogen time, and partial thromboplastin time, were within normal limits. He was given epidural...

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Section: Discussionmentioning

confidence: 99%

Penile Erection During Transurethral Surgery

Baltogiannis

Charalabopoulos

Giannakopoulos

et al. 2006

Journal of Andrology

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“…To date, many pharmacological treatments to produce detumescence have been proposed, such as intracavernous injection of ephedrine, phenylephrine, metaraminol, noradrenaline and adrenaline [4,[7][8][9][10] or intravenous injection of ketamine [6,[11][12][13], dexmedetomidine [5], terbutaline [14] and glycopyrrolate [15].…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Background: To assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition. Methods: 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 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. Results: The 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. Conclusions: In 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.

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“…This challenge should be weighted between operating on ill-patient facing the challenges of general anaesthesia and a conscious patient with the option of better recovery profile and earlier discharge from the hospital. Although many pharmacologic agents [12,13,14] have been used to treat tumescence that arises from the effect of anaesthesia, the attending surgeon should properly evaluate the patient for co-morbidities and agent (s) used as some of these medications could have deleterious effect.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Spinal Anaesthesia on Penile Tumescence

Fyneface-Ogan¹

2018

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It is a common observation that following spinal anaesthesia, the penis usually elongates. The aim of this study was to determine the degree of change in penile length following spinal anaesthesia. Consecutive urosurgical patients undergoing spinal anaesthesia were recruited for this study. Those who received general anaesthesia or incomplete spinal blocked were also excluded. The flaccid length of the penis was measured before and after the administration of spinal anaesthesia. Penile length 15 minutes post-spinal anaesthesia was measured and recorded. The change in length was tested for statistical significant difference, the age of patient; diagnosis and type of surgery were also recorded. Forty three patients completed the study. Benign prostatic hypertrophy constituted 41.9% of the surgical indications. While 53.5% of the patients were ASA I, 39.5% and 7.0% of them were ASA II and III respectively. While the mean initial penile length was 12.1 ± 0.53 cm and the mean final length was 15.7 ± 0.53 cm, the mean maximal change in penile length was 3.6±1.5 cm; p<0.0001. There was no statistical correlation between age and mean differential change in length of penis (r=-0.2842, p=0.43). It was therefore concluded that there was a significant change in penile length (tumescence) following successful spinal anaesthesia.

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Intracavernous Injection of Noradrenaline to Interrupt Erections during Surgical Interventions

Cited by 21 publications

References 3 publications

Penile Erection During Transurethral Surgery

Penile Erection During Transurethral Surgery

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

The Effect of Spinal Anaesthesia on Penile Tumescence

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