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

Abstract

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.

Remifentanil-induced penile erection in elderly patients undergoing urethroscopic surgery

“…Since then, we still have encountered a few cases of penile erection in patients undergoing urethroscopic procedures. However, it has been reported that penile erection under spinal or general anesthesia at the time of urethroscopic surgery occurs at a reported incidence of 0.1-2.4% [4]. However, by our estimation, it does not feel like that the rate of penile erection with remifentanil is not lower than the previously reported ones.…”

“…To the best of our knowledge, this is the first report of remifentanil-induced penile erection in elderly patients undergoing urethroscopic procedures. Because urethroscopic surgery is usually performed under spinal anesthesia without the use of remifentanil and penile election is rarely seen under spinal anesthesia [4], intraoperative penile erection by remifentanil is hardly detectable. However, it should be understood that this phenomenon can occur in not only male children and young adults, but also elderly patients.…”

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial

“…Partial or complete erection during general anesthesia in urologic surgery is a relatively rare but challenging condition with an incidence of 0.1 to 2.4%. While the cause is unknown, it is generally possible that stimulating the penis while preparing the skin or the tool used for the procedure may be the main cause of the erection (2).…”

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

“…[ 1 ] This makes the penile instrumentation cumbersome resulting in difficulty to perform the procedure safely, thus exposing the patient to a greater risk of complications such as urethral trauma, bleeding, and stricture formation. [ 1 2 ] Rarely, it may lead to postponement of the procedure.…”

“…Others have reported the use of intravenous ketamine, glycopyrrolate, dexmedetomidine, and terbutaline,[ 2 8 9 10 ] and some have reported inhalation of salbutamol[ 11 ] for managing intraoperative erection.…”