Penile Erection During Transurethral Surgery

Abstract

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...

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

“…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][2][3][4]. While the etiology is unclear, it generally follows the local stimulation of the penis during skin preparation or instrumentation [3,5].…”

“…While the etiology is unclear, it generally follows the local stimulation of the penis during skin preparation or instrumentation [3,5]. Intraoperative penile erection may lead to delay or cancellation of the surgery by impeding urological instrumentation or safely reaching the prostate or bladder together with the greater risk of complications such as bleeding, urethral trauma and stricture formation [2,4,6].…”

Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block

“…Caudal epidural block is more popular but may result in penile engorgement intraoperatively. Penile engorgement following epidural anesthesia occurs because of vasodilatation and pooling of blood in the venous sinuses of the penis (6). Engorgement is troublesome to the surgeon and may adversely affect surgical outcome.…”

Ultrasound-guided penile nerve block in pediatrics: An answer to intraoperative priapism

“…Prolonged priapism can lead to edema and necrosis of penis. [3] Prognosis depends on the type of priapism and the duration of time elapsed before the therapeutic intervention. There are two main types of priapism: (1) Low flow or ischemic priapism: this is more painful and is seen in sickle-cell disease, leukemia, malaria, etc., (2) High flow or nonischemic priapism: this is less painful and is mostly seen in trauma patients and during surgery.…”