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Intravenous dexmedetomidine for treatment of intraoperative penile erection

  • Urology – Original Paper
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Abstract

Background

Intraoperative penile erections following the initiation of either regional or general anaesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel the planned surgery. The aetiology is unclear. Various treatments proposed for producing detumescence are not always effective. Use of intracavernous alpha-adrenergic agonists is an efficient and rapid but short-lasting treatment. Furthermore, repeated intracavernous injections of vasoactive drugs may be harmful. Dexmedetomidine is a potent, selective α2-adrenoreceptor agonist. In our study, we evaluated the effect of dexmedetomidine on intraoperative penile erection.

Methods

Penile erection developed during an endoscopic procedure in 12 more than 7,800 patients. Anaesthesia used was general in 3 patients, epidural in 1 patient and spinal in 8 patients. The erection rigidity was evaluated by the operating urologist. Dexmedetomidine was diluted in normal saline to a concentration of 4 μg/ml. In all of the cases, 0.5 μg/kg dexmedetomidine was injected intravenously.

Results

The incidence of intraoperative penile erection was 0.34% for general anaesthesia, 0.11% spinal anaesthesia and 1.72% epidural anaesthesia at our institution. Detumescence was achieved in 9 patients during the first 5 min and in one patient at the 9th minute after a single intravenous dexmedetomidine (83%). There was no detumescence in two patients after 15 min (17%).

Conclusion

This study demonstrated that 0.5 μg/kg intravenous injection of dexmedetomidine is a simple, effective and safe method for immediate relief of intraoperative penile erection with high success rate.

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References

  1. Baltogiannis DM, Charalabopoulos AK, Giannakopoulos XK, Giannakıs DJ, Sofikitis NV, Charalabopoulos KA (2006) Penile erection during transurethral surgery. J Androl 27:376–380

    Article  PubMed  Google Scholar 

  2. Welti RS, Brodsky JB (1980) Treatment of intraoperative penile tumescence. J Urol 124:925–926

    PubMed  CAS  Google Scholar 

  3. Staerman F, Nouri M, Couerdacier P et al (1995) Treatment of the intraoperative penile erection with intracavernous phenylephrine. J Urol 153:1478–1481

    Article  PubMed  CAS  Google Scholar 

  4. Won YJ, Hong JY (2008) Penile erection during transurethral surgery—case report and review of the literature. Anesth Pain Med 3:154–156

    Google Scholar 

  5. Siegel JF, Reda E (1997) Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapism in a child. J Urol 157:648

    Article  PubMed  CAS  Google Scholar 

  6. De Meyer JM, De Sy WA (1986) Intracavernous injection of noradrenaline to interrupt erections during surgical interventions. Eur Urol 12:169–170

    PubMed  Google Scholar 

  7. Zappala SM, Howard PJ, Hopkins TB, Blute RD (1992) Management of intraoperative penile erections with diluted epinephrine solution. Urology 40:76–77

    Article  PubMed  CAS  Google Scholar 

  8. Tsai SK, Hong CY (1990) Intracavernosal metaraminol for treatment of intraoperative penile erection. Postgrad Med J 66:831–833

    Article  PubMed  CAS  Google Scholar 

  9. Benzon HT, Levanthol JB, Ovassapian A (1983) Ketamine treatment of penile erection in the operating room. Anesth Analg 62:457–458

    Article  PubMed  CAS  Google Scholar 

  10. Appadu B, Calder I (1991) Ketamine does not always work in treatment of priapism. Anaesthesia 46:426–427

    Article  PubMed  CAS  Google Scholar 

  11. Walley MA, Sang CN (1994) Use of glycopyrrolate to treat intraoperative penile erection: case report and review of the literature. Reg Anesth 19:423–428

    Google Scholar 

  12. Shantha TR (1989) Intraoperative management of penile erection by using terbutaline. Anesthesiology 70:707–709

    Article  PubMed  CAS  Google Scholar 

  13. Vaidyanathan S, Watt JW, Soni BM, Krishnan KR (1996) Intravenous salbutamol treatment for penile erection arising during cystoscopy of cervical spinal cord injury patients. Spinal Cord 34:691–695

    Article  PubMed  CAS  Google Scholar 

  14. Maan Z, Arya M, Patel HRH (2003) Priapism—a review of the medical management. Expert Opin Pharmacother 4:2271–2277

    Article  PubMed  CAS  Google Scholar 

  15. Belleville JP, Ward DS, Bloor BC, Maze M (1992) Effects of IV dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 77:1125–1133

    Article  PubMed  CAS  Google Scholar 

  16. Bloor BC, Ward DS, Belleville JP, Maze M (1992) Effects of IV dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 77:1134–1142

    Article  PubMed  CAS  Google Scholar 

  17. Flacke JW (1992) α2-adrenergic agonists in cardiovascular anesthesia. J Cardiothorac Vasc Anesth 6:344–359

    Article  PubMed  CAS  Google Scholar 

  18. Saeed M, Holtz J, Elsner D, Bassenge E (1985) Sympathetic control of myocardial oxygen balance in dods mediated by activation of coronary vascular α2-adrenoceptors. J Cardiovasc Pharmacol 7:167–173

    Article  PubMed  CAS  Google Scholar 

  19. Chen DG, Dai XZ, Zimmerman BG, Bache RJ (1988) Postsynaptic Postsynaptic α1- and α2-adrenergic mechanisms in coronary vasoconstriction. J Cardiovasc Pharmacol 11:61–67

    Article  PubMed  Google Scholar 

  20. Ramsey MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2:656–659

    Article  Google Scholar 

  21. Pertek JP, Coissard A, Artis M (1996) Dorsal nerve block for intraoperative management of penile erection. Reg Anesth 21:491–492

    PubMed  CAS  Google Scholar 

  22. Kouriefs C, Watkin NA (2003) What to do if it gets ‘bigger’. Ann R Coll Surg Engl 85(2):126–128

    Article  PubMed  CAS  Google Scholar 

  23. Villalonga A, Beltran J, Gomar C, Nalda MA (1985) Ketamine for treatment of priapism. Anest Analg 64:1033–1034

    Article  CAS  Google Scholar 

  24. Ravindran RS, Dryden GE, Somerville GM (1982) Treatment of priapism with ketamine and physostigmine. Anesth Analg 61:705–707

    PubMed  CAS  Google Scholar 

  25. Shantha TR, Finnerty DP, Rodriquez AP (1989) Treatment of persistent penile erection and priapism using terbutaline. J Urol 141:1427–1429

    PubMed  CAS  Google Scholar 

  26. Dittrich A, Albrecht K, Bar-Moshe O, Vandendris M (1991) Treatment of pharmacological priapism with phenylephrine. J Urol 146:323–324

    PubMed  CAS  Google Scholar 

  27. Clark JT, Smith ER, Davidson JM (1985) Evidence for the modulation of sexual behavior by alpha-adrenoceptors in male rats. Neuroendocrinology 41:36–43

    Article  PubMed  CAS  Google Scholar 

  28. Maze M, Tranquili W (1991) Alpha2-adrenoceptor agonists: defining the role in clinical anaesthesia. Anesthesiology 74:581–605

    Article  PubMed  CAS  Google Scholar 

  29. Kunisawa T, Nagata O, Nagashima M, Mitamura S, Ueno M, Suzuki A, Takahata O, Iwasaki H (2009) Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation. J Clin Anesth 21:194–199

    Article  PubMed  CAS  Google Scholar 

  30. Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H (1990) Dexmedetomidine, an alpha 2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology 73:230–235

    Article  PubMed  CAS  Google Scholar 

  31. Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M (1992) Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 68:126–131

    Article  PubMed  CAS  Google Scholar 

  32. Memiş D, Turan A, Karamanlıoğlu B, Şeker Ş, Pamukçu Z (2008) Dexmedetomidine reduces rocuronium dose requirement in sevoflurane anaesthesia. Curr Anaesth Crit Care 19:169–174

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Medical Faculty, Erciyes University, Kayseri, Turkey

    Gulen Guler, Fatih Ugur, Recep Aksu & Adem Boyaci

  2. Department of Urology, Medical Faculty, Erciyes University, Kayseri, Turkey

    Mustafa Sofikerim

  3. Anesteziyoloji Anabilim Dali, Erciyes Universitesi Tip Fakultesi, 38039, Kayseri, Turkey

    Gulen Guler

Authors
  1. Gulen Guler
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  2. Mustafa Sofikerim
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  3. Fatih Ugur
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  4. Recep Aksu
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  5. Adem Boyaci
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Correspondence to Gulen Guler.

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Guler, G., Sofikerim, M., Ugur, F. et al. Intravenous dexmedetomidine for treatment of intraoperative penile erection. Int Urol Nephrol 44, 353–357 (2012). https://doi.org/10.1007/s11255-011-0023-x

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  • DOI: https://doi.org/10.1007/s11255-011-0023-x

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