Intraoperative erection during lower urinary tract surgery

Erection is a rare event during lower urinary tract surgery When it is extr emely refractory, endoscopy is impossible and the lower urinary tract surge ry may need to be deferred The development of erection during spinal anaest hesia is due to manipulations before complete installation of sensory block or incomplete blockade of sacral segments (S2 to S4) supplying the nervi e rigentes. The mechanism of erection during general anaesthesia remains poor ly elucidated. General anaesthesia may suppress central or peripheral sympa thetic control of flaccidity. The peripheral target could be the smooth mus cle of the cavernous tissue, either by a direct action or via alpha-adrener gic receptors. Psychogenic and reflexogenic stimuli have also been proposed , possibly facilitated by amplification of sensations during stage II anaes thesia. The various treatments are bused on experience acquired in the field of pri apism. Systemic treatments such as ketamine an beta2 mimetics or benzodiaze pines are not always effective and are associated with considerable adverse effects. Intracavernous injections of alpha-adrenergic drugs constitute th e treatment of choice. Phenylephrine and etilefrine are preferred because o f their rapid efficacy and particularly their only moderate cardiovascular adverse effects.