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

Abstract

Introduction Although the breakage and entrapment of the needles inside the penis during intracavernosal self-injection for erectile dysfunction treatment is a rare complication, when it happens, it can cause significant distress and anxiety to the patients who experience it. Aims Our work aims to report a case of retained penile needle and to compare it with similar cases in the literature to define the risk factors and the best practice to prevent and treat this complication. Methods We are reporting successful surgical removal of a deeply retained penile needle with the aid of intraoperative fluoroscopy after an unsuccessful attempt of ultrasound-guided removal in the emergency room. We searched the PubMed and Embase databases for similar cases and compared the findings across all the cases. Results In our case, the needle was initially superficial; however, excessive manipulation in the emergency room resulted in deep displacement into the corpus cavernosum. We were able to successfully localize the needle using intraoperative fluoroscopic guidance. The needle was then surgically removed via a small skin incision with minimal dissection of cavernosal tissue. We identified 15 reported cases of retained penile needles in the literature and performed a comprehensive comparison among all the cases. It is critical to search for specialized treatment with a urologist to avoid great damage due to erroneous manipulation of the corpora cavernosa. Conclusion Selecting patients with good manual dexterity is essential to avoid breakage and entrapment of penile needles during intracavernosal self-injection for erectile dysfunction treatment. The management of retained penile needles should be individualized depending on the clinical picture at the time of presentation. It is critical to avoid excessive manipulation as it can push the needle deeper into the penis and make the extraction more demanding.

Migrating Foreign Bodies of Penis: A Case Report

“…Although there have been 16 reported cases of ICIassociated needle breakage and retention abroad, the needle was placed into the penile body rather than the glans at the time of injection. As of yet, no similar case has been reported in China [3] . In particular, this case combines the simultaneous presence of two rare clinical conditions: foreign bodies within the penile cavernous body, and the coexistence of glans cleft and hypospadias in the patient.…”

“…The third dilemma is related to the spongy tissue structure of penis, which can reduce the surgeon's tactile feedback and makes it possible to miss thin needles even within intraoperative uoroscopic guidance. Therefore, in order to avoid pushing the needle deep into the penile tissues and rendering its removal more di cult, it is recommended that emergency departments seek assistance from experienced andrologists rst when confronted with patient with an intracorporeal needle break in the penile cavernous body [3] .…”

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

“…Finally, the needles all be removed through a local incision in the penis. As of yet, no similar cas e has been reported in China [ 15 ]. In particular, this case encompasses the simultaneous presence of two uncommon clinical conditions: foreign bodies within the penile cavernous body, and the coexistence of glans cleft and hypospadias in the patient.…”

“…The third dilemma is related to the spongy tissue structure of penis, which may reduce the surgeon’s tactile feedback and increase the likelihood of missing thin needles even with intraoperative fluoroscopic guidance. Therefore, to prevent excessive manipulation that could potentially push the needle further into deeper penile tissues and consequently complicate its retrieval, it is recommended that emergency departments seek assistance from experienced andrologists first in cases of intracorporeal needle break in the penile cavernous body [ 15 ].…”

“…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. Midshaft of right corpus cavernosum Local area of the penis General anesthesia ICI intracavernosal injection therapy …”