BACKGROUND To assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition. METHODS Of 402 endoscopic urological procedures performed in our clinic over a 4-year (2015-2019) period, a total of 9 cases with intraoperative penile erection impeding instrumentation during endourological surgery were included. Data on patient age, weight, height, American Society of Anesthesiologists (ASA) physical status classification system scores, type and duration of surgery, type and level of anesthesia, onset of erection, treatment characteristics and treatment outcome were recorded for each patient. RESULTS The mean (SD) age was 68.3 years (range, 66.0-77.0 years). ASA physical status category I and II were noted in 55.6 and 44.4% of patients, respectively. All cases received spinal anesthesia (n = 9) at T8-10 dermatome levels, for TURP in 7 (77.8%) cases and for TURBT in 2 (22.2%) cases. The onset of penile erection was post-urethroscope in 7 (77.8%) cases. The average total ketamine dose was 34.3 mg (range, 18.0-75.0 mg). The average duration of the operation was 91.7 min (range, 40.0-140.0 min). Ketamine treatment resulted in resolved erection with delayed procedure in 7 (77.8%) cases, while conversion to general anesthesia was required in 2 (22.5%) cases. CONCLUSIONS In conclusion, the prevalence of intraoperative penile erection during spinal anesthesia for endourological surgery was 2.2% in our experience. These findings demonstrated that intravenous injection of ketamine is an effective and safe method for immediate resolution of intraoperative penile erection with a high success rate.

中文翻译：

---

静脉内氯胺酮在术中阴茎勃起管理中的效用：回顾性单中心分析，历时4年之久。

背景技术在我们的呼吸内科实践中评估术中阴茎勃起的患病率以及静脉内氯胺酮在疾病控制中的实用性。方法我们的诊所在4年（2015-2019年）期间进行了402例内窥镜泌尿外科手术，其中包括9例在泌尿外科手术期间进行术中阴茎勃起阻碍器械治疗的病例。记录每位患者的患者年龄，体重，身高，美国麻醉医师学会（ASA）身体状况分类系统评分，手术类型和持续时间，麻醉类型和水平，勃起发作，治疗特征和治疗结果等数据。结果平均（SD）年龄为68.3岁（范围66.0-77.0岁）。分别在55.6％和44.4％的患者中发现ASA身体状况I和II类。所有病例均在T8-10皮肤刀水平上接受了脊髓麻醉（n = 9），TURP 7例（77.8％），TURBT 2例（22.2％）。阴茎勃起是在尿道镜后发生的（7.8％）。平均氯胺酮总剂量为34.3 mg（范围为18.0-75.0 mg）。手术的平均持续时间为91.7分钟（范围为40.0-140.0分钟）。氯胺酮治疗导致7例（77.8％）的病例出现了勃起的延迟解决，而2例（22.5％）的病例需要改用全身麻醉。结论总之，根据我们的经验，术中在进行麻醉的脊柱麻醉术中阴茎勃起的发生率为2.2％。这些发现表明，氯胺酮的静脉内注射是立即解决术中阴茎勃起的一种有效且安全的方法，成功率很高。