Intraoperative Priapism during Neuraxial Anaesthesia Resulting in Trouble to the Urologist: A Case Report


Vol 4 | Issue 2 | May-Aug 2018 | page: 30-32 | Garg Jyoti, Ho Vui Kian, Challa Satish Kumar.

Authors: Garg Jyoti [1], Ho Vui Kian [1], Challa Satish Kumar Reddy [3].

[1] Department of anaesthesia, Sengkang General Hospital, Singapore.

[2] Department of Anaesthesia, Singapore General Hospital, Singapore.

[3] Department of Anaesthesia, KK Women’s and Children’s Hospital, Singapore.

Address of Correspondence

Dr. Garg Jyoti,
CU-102, Vishakha Enclave,
Pitam Pura, Delhi, 110034, India.


Introduction: Priapism following neuraxial anaesthesia for urological endoscopic procedures is uncommon and may result in delay or even postponement of scheduled operations. An imbalance between sympathetic and parasympathetic nervous system usually contributes to intraoperative penile erection, although local stimulation before complete sensory blockade may also lead to priapism.

Case Report: We discuss a case of successful management of priapism in 47-year-old Chinese male patient listed for transurethral resection of bladder tumor following a subarachnoid block.

Conclusion: With a detailed knowledge about the pathophysiology of intraoperative penile erection, anaesthesiologist can appropriately direct treatment depending on the individual patient and hence minimize the risks of subsequent complications.

Keywords: Priapism, spinal anaesthesia, glycopyrrolate, phenylephrine.


  1. . Baltogiannis DM, Charalabopoulos AK, Giannakopoulos XK, Giannakis DJ, Sofikitis NV, Charalabopoulos KA. Penile erection during transurethral surgery. J Androl 2006;27:376-80.
  2. Greene NM. Physiology of Spinal Anesthesia. 3rd ed. Baltimore: William and Wilkins; 1981.
  3. Pertek JP, Coissard A, Artis M. Dorsal nerve block for intraoperative management. Reg Anesth 1996;21:491-2.
  4. Benzon HT, Leventhal JB, Ovassapian A. Ketamine treatment of penile erection in the operating room. Anesth Analg 1983;62:457-8.
  5. Valley MA, Sang CN. Use of glycopyrrolate to treat intraoperative penile erection. Reg Anesth 1994;19:423-8.
  6. Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: Mechanisms, management, and prevention. Br J Anaesth 2009;102:73948.
  7. Van Arsdalen KN, Chen JW, Smith MJ. Penile erections complicating transurethral surgery. J Urol 1983;12:374-6.
  8. Ravindram RS, Dryden GE, Somerville GM. Treatment of priapism with ketamine and physostigmine. Anesth Analg 1982;61:705-7.
  9. Seftel AD, Resnick MJ, Boswell MV. Dorsal nerve block for the management of intraoperative penile erection. J Urol 1994;151:394-5.
  10. Bosch RJ, Benard F, Aboseif SR, Stief CG, Lue TF, Tanagho EA. Penile detumescenece; Characterization of three phases. J Urol 1991;146:86771.
  11.  Walther PJ, Meyer AF, Woodworth BE. Intraoperative management of penile erection with intracorporeal phenylephrine during endoscopic surgery. J Urol 1987;137:738-9.
  12. Natarajan P, Remadevi R., Rao PB, Ramachandran TR. Priapism following spinal anesthesia in urological procedures. Anaesth Pain Intensive Care 2012;16:47-50.
  13. Shantha TR. Intraoperative management of penile erection by using terbutaline. Anesthesiology 1989;70:707-9.
  14. Prakash S, Sharma S, Miglani S, Gogia AR. Management of intraoperative penile erection with salbutamol aerosol. J Anaesthesiol Clin Pharmacol 2012;28:402-3.

How to Cite this Article: Garg J, Ho HV, Reddy CSK. Intraoperative Priapism during Neuraxial Anaesthesia Resulting in Trouble to the Urologist: A Case Report.. Journal of Anaesthesia and Critical Care Case Reports May-Aug 2018; 4(2);30-32.

(Abstract)      (Full Text HTML)      (Download PDF)


Tags: , , ,