Priapism during transurethral surgery under spinal anaesthesia: Implications and review of management options

Das, Jyotirmoy; Deuri, Achyut; Roy, Preety Mittal; Pant, Vijaya

doi:10.4103/0019-5049.72654

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…5 Imbalance between sympathetic and parasympathetic nervous system is considered as the underlying cause of intra operative priapism. 8 Psychogenic or reflex erection can occur during local stimulation during washing or instrumentation during early stage of neuraxial block before complete sensory block. 6 Another possible explanation is incomplete blockade of sacral segments of the spinal cord during spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Bhutia¹,

Bhattarai²,

Bhutia³

et al. 2021

IJCA

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Priapism following neuraxial anesthesia or general anesthesia is a rare but problematic event which may result in delay, complication or even cancellation of scheduled operations in urological endoscopic procedures. We present a case of successful management of intra operative priapism in a 32 years old male under spinal anesthesia posted for Ureteroscopic Lithotripsy (URSL) of bilateral ureteric stone.Different therapies for management of intra operative priapism have been quoted in the past like intracorporeal injection of vasopressors, dorsal penile nerve block, intravenous glycopyrrolate, intravenous ketamine/dexmedetomidine etc. In this case we treated with intravenous glycopyrrolate and intracorporeal injection of ultra low dose phenylephrine.

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Section: Discussionmentioning

confidence: 99%

Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Bhutia¹,

Bhattarai²,

Bhutia³

et al. 2021

IJCA

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show abstract

“…also encountered the same and had to call off the surgery. [ 3 17 ] Early intervention has been emphasized in these cases as the duration of the erection is the critical factor for the successful detumescence of the penis and minimizing the risks of complications such as fibrosis and thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of ultra-low-dose intracavernosal adrenaline for intraoperative penile erection in transurethral surgeries under spinal anesthesia

Gupta

Gupta²,

Mahajan

2020

Anesth Essays Res

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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.

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“…Penile tumescence and priapism can be seen due to anesthetic agents used in spinal or general anesthesia, or due to an imbalance between sympathetic and parasympathetic nerve systems ( 16 ). This situation can cause interruptions in transurethral approaches or a complete cancellation of surgery ( 16 ). The main reason for this is the hemorrhage risk and urethral trauma caused by the transurethral operation.…”

Section: Discussionmentioning

confidence: 99%

A new surgical technique: transvesical resection of prostate - case series

2018

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Objective:To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra.Materials and Methods:Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery.Results:Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively.Conclusion:In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

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Priapism during transurethral surgery under spinal anaesthesia: Implications and review of management options

Cited by 8 publications

References 5 publications

Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Safety and efficacy of ultra-low-dose intracavernosal adrenaline for intraoperative penile erection in transurethral surgeries under spinal anesthesia

A new surgical technique: transvesical resection of prostate - case series

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