Management of intraoperative penile erections with diluted epinephrine solution

Zappala, Stephen; Howard, Philip J.; Hopkins, Timothy B.; Blute, Robert D.

doi:10.1016/0090-4295(92)90442-y

Cited by 17 publications

(11 citation statements)

References 3 publications

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“…The methods and drugs mentioned in the previous paragraph are ineffective in many cases (Walther et al, 1987; Miller and Galizia, 1993; Seftel et al, 1994; Staerman et al, 1995). Studies in the past 2 decades have referred to the safe and successful use of intracorporeal injections of α‐adrenergic agonists, such as epinephrine (Mels et al, 1991; Zappala et al, 1992) and phenylephrine (Walther et al, 1987; McNicolas et al, 1989), in cases of intraoperative penile erection. At present, intracavernous injection of α‐adrenergic agonists is used in several research protocols to treat penile erection occurring during transurethral surgery.…”

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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“…12 ± 14 In a study in which no blood aspiration was performed, 88% of the patients with priapism were reported to have detumescence after injection of intracavernosal phenylephrine. 15 In a study by Zappala et al, 16 ®ve patients having intra-operative rigid erections were administrated diluted epinephrine and lidocaine solution and Intracavernosal adrenalin injection in priapism D Keskin et al rigidity was resolved in all cases. However, these patients cannot be regarded as having true priapism.…”

Section: Discussionmentioning

confidence: 99%

Intracavernosal adrenalin injection in priapism

et al. 2000

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Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the ef®cacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1a100 000) was injected in each cavernosal body. In the patients who did not respond to the ®rst injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the ®rst injection. Repeated adrenalin injections (2 ± 5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no signi®cant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high ef®cacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.

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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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Management of intraoperative penile erections with diluted epinephrine solution

Cited by 17 publications

References 3 publications

Penile Erection During Transurethral Surgery

Penile Erection During Transurethral Surgery

Intracavernosal adrenalin injection in priapism

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

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