Removal of retained intracavernous needle tip using intraoperative fluoroscopy

Abstract

Intracavernous injections of vasoactive drugs, such as alprostadil, are widely used as an effective treatment method for erectile dysfunction. Intracavernous breakage of the needle is a very rare complication of self-injections, with only a few case reports available in the current literature. Treatment methods described vary in the literature, ranging from immediate surgical exploration under ultrasound guidance to non-operative management with delayed needle removal once it is easily palpable. We report a case of an 82-year-old man with a retained intracavernous 1 cm 30 gauge needle tip after injection of alprostadil (Caverject; marketing authorisation number PL 00057/0942) and the innovative use of intraoperative X-ray imaging (fluoroscopy) for removal of this. Level of evidence: level 5 (case report/technique)

Retained needles during intracavernosal self-injection for erectile dysfunction treatment: a case report and systematic literature review

“… 7 The youngest patient who experienced this complication was 32 years old, 8 while the oldest was 82 years old. 14 Among the 16 cases, Bimix was used in only 1 case, 12 papaverine in 4 cases, 2-4 , 8 prostaglandin E1 (alprostadil/Caverject) in 4 cases (including ours), 6 , 7 , 14 and Trimix in just 1 case. 11 The pharmacologic agent was not mentioned in 6 cases.…”

“…We utilized intraoperative fluoroscopy to localize the needle, similar to 5 cases. 3 , 4 , 10 , 12 , 14 However, we could not localize the needle by using intraoperative ultrasonography as in the case by Lazaraviciute et al 14 Specifically, we could not localize it by intraoperative ultrasonography due to excessive manipulation and prior trials to remove the needle in the ER. Intraoperative ultrasonography successfully localized the needle in 4 cases.…”

“… 5 , 9 , 10 , 13 , 15 Breakage and retention of the needle can happen as soon as during the second self-ICI dose 5 or after 20 years of self-ICI. 14 …”

“…Three cases were asymptomatic on presentation. 6 , 9 , 11 The remaining cases demonstrated varying degrees of pain and swelling, ranging from mild pain 8 , 14 , 15 to severe pain associated with penile hematoma, cellulitis, or abscess. 5 , 7 , 12 On physical examination, we could not palpate the needle in our patient, as opposed to 4 cases 2 , 4 , 10 , 15 where the retained needle was palpable.…”

Migrating foreign bodies of penis: a case report and literature review

“…Left corpus cavernosum Local area of the penis General anesthesia, penile degloving Pan (2019) [ 11 ] 1 51 ICI NO Several months Ultrasound and CT scan Under Dartos fascia (right side of penile base) Local area of the penis General anesthesia Collaço(2020) [ 12 ] 1 54 ICI NO Immediate X-ray and ultrasound Intracorporal. Left corpus cavernosum Local area of the penis General anesthesia Lazaraviciute(2021) [ 13 ] 1 82 ICI NO 1 d X-ray and ultrasound Intracorporal. Left corpus cavernosum Local area of the penis General anesthesia Mai (2021) [ 14 ] 1 64 ICI YES Immediate X-ray and ultrasound Under Dartos fascia (left midshaft) Local area of the penis General anesthesia Kirolos(2023) [ 15 ] 1 70 ICI NO 2 d Ultrasound Intracorporal.…”