Penile Erection during Transurethral Surgery : Case report and review of the literature

ABSTRACT

Imbalance between sympathetic and parasympathetic nervous systems is generally considered an underlying mechanism for intraoperative erection, although local stimulation before complete sensory blockade can contribute to the problem. With the onset of erection under regional anesthesia during an operative procedure, general inhalational anesthesia must be quickly initiated to enhance venous drainage of the engorged corpora cavernosa before prolonged venous stasis. Combination therapy including ketamine, glycopyrrolate, terbutaline, and alpha-adrenergics may be available, however, the benefit-risk ratio should be considered especially in the elderly patients with cardiovascular diseases. We present a case of intraoperative erection in an elderly patient, which was resolved by applying inhalational anesthesia with remifentanil after confirmation ineffectiveness of intravenous glycopyrrolate and ketamine. We also review and discuss the treatment strategies.