Abstract
Two patients with long-standing tetraplegia after spinal cord injury developed reflex penile erection in the operation theatre. One had not received any anaesthesia, and penile erection occurred after introduction of the cystoscope into the urethra, and also autonomic dysreflexia. Intravenous salbutamol, in a dose of 10 micrograms, produced immediate and persistent penile detumescence and salbutamol-induced fall in blood pressure was of therapeutic value. In the second patient, penile erection occurred during general anaesthesia prior to cystoscopy. Immediate and persistent penile detumescence was achieved with intravenous salbutamol 20 micrograms. There was transient fall of blood pressure which responded to intravenous infusion of 0.9% sodium chloride. Salbutamol-induced fall in blood pressure is of therapeutic value in those spinal cord injury patients who develop, in addition to penile erection, autonomie dysreflexia precipitated by urethral instrumentation, or bladder distension with the irrigating fluid. Intravenous salbutamol is preferable to intra-cavernosal phenylephrine, noradrenaline, metaraminol, and epinephrine, or intravenous ephedrine which are contra-indicated in patients with hypertension.
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Staerman F et al. Treatment of the intra-operative penile erection with intra-cavernous phenylephrine. J Urol 1995; 153: 1478–1481.
Malakondaiah G C et al. A comparative study of gentamicin pharmacokinetics in spinal cord-injured with incomplete spinal lesion and healthy adults. Indian Journal of Urology 1987; 3: 78–81.
Sankaranarayanan A, Hemal A K, Pathak C M, Vaidyanathan S . Serum gentamicin levels in traumatic paraplegics following intramuscular administration in non-paralysed limbs. International Journal of Clinical Pharmacology, Therapy, Toxicology 1989; 27: 540–543.
Segal L J, Brunnemann S R . Clinical pharmacokinetics in patients with spinal cord injuries. Clinical Pharmacokinetics 1989; 17: 109–129.
Watt J, Krishnan K R . Prise en charge du blesse medullaire a la phase aigue. In: Gajdos PH, Loh L (eds). Reanimation et Neurologic Arnette Blackwell: Paris, 1995, pp 144–145.
Campbell B, Brien J E . Pharmacokinetics in spinal cord injured patients. American Journal of Hospital Pharmacy 1995; 25: 327–332.
Weiss H D . The physiology of human penile erection. Annals of Internal Medicine 1972; 76: 795–799.
Steers W D . Neural control of penile erection. Semin Urol 1990; 8: 66–79.
Soni B M, Vaidyanathan S, Krishnan K R . Management of pharmacologically induced prolonged penile erection with oral terbutaline in traumatic paraplegics. Paraplegia 1994; 32: 670–674.
Shantha T R . Intra-operative management of penile erection by using terbutaline. Anaesthesiology 1989; 70: 707–709.
Morgan D J et al. Pharmacokinetics of intravenous and oral salbutamol and its sulphate conjugate. British Journal of Clinical Pharmacology 1986; 22: 587–593.
McNicholas T A, Thomson K, Rogers H S, Blandy J P . Pharmacological management of erections during transurethral surgery. Br J Urol 1989; 64: 435–436.
Miyabe M, Namiki A . Ephedrine for treatment of penile erection during spinal anaesthesia. Anesth Analg 1988; 67: 1019–1020.
Miller P D, Galizia E J . Management of erections during transurethral surgery using ethyl chloride spray. Br J Urol 1993: 71: 105.
Seftel A D, Resnick M I, Boswell M V . Dorsal nerve block for management of intra-operative penile erection. J Urol 1994; 151: 394–395.
Sachs B D . Placing erection in context: the reflexogenic-psychogenic dichotomy reconsidered. Neurosciences and Biobehavioral Reviews 1995; 19: 211–224.
Valley M A, Sang C N . Use of glycopyrrolate to treat intraoperative penile erection. Case report and review of the literature. Regional Anaesthesia 1994; 19: 423–428.
Giuliano F A, Rampin O, Benoit G, Jardin A . Neural control of penile erection. Urol Clin North Am 1995; 22: 747–766.
Burnett A L et al. Nitric oxide: A physiologic mediator of penile erection. Science 1992; 257: 401–403.
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Vaidyanathan, S., Watt, J., Soni, B. et al. Intravenous salbutamol treatment for penile erection arising during cystoscopy of cervical spinal cord injury patients. Spinal Cord 34, 691–695 (1996). https://doi.org/10.1038/sc.1996.125
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DOI: https://doi.org/10.1038/sc.1996.125
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