Intraoperative penile erection (IPE) presents a unique challenge during urological surgeries, often leading to complications such as surgical delays and potential postoperative issues, including erectile dysfunction. Traditional detumescence methods, primarily involving intracavernosal vasoactive agents, are invasive and associated with significant risks, including localized pain and systemic side effects. Therefore, there is a clinical imperative to explore alternative non-invasive strategies with better safety profiles.
Esketamine, a non-barbiturate anesthetic with sympathomimetic properties, offers a potential solution due to its ability to restore sympathetic dominance disrupted during anesthesia. This retrospective clinical study aimed to assess the efficacy and safety of intravenous esketamine compared to ephedrine for managing IPE, addressing existing gaps in knowledge surrounding treatment mechanisms.
Study Design and Results
Recent study conducted at Wuhan No.1 Hospital, data were collected from male patients who underwent various urological procedures from January 2021 to December 2023. Among 3,848 procedures, 37 cases of IPE were analyzed, administered either esketamine or ephedrine based on clinical judgment. The success of treatment was defined as the resolution of erection allowing surgical continuation within ten minutes. Intravenous esketamine showed a 96.3% success rate, whereas ephedrine demonstrated 80%. Notably, detumescence was achieved more rapidly with esketamine (average of 3.0 minutes) compared to ephedrine (5.5 minutes), indicating a statistically significant advantage.
Safety Assessments
Safety assessments revealed fewer cardiovascular events associated with esketamine, such as hypertension and tachycardia, compared to ephedrine, which aligns with the expected pharmacological profiles. While minor neuropsychiatric effects were monitored, no significant differences were noted between groups regarding recovery times or postoperative adverse events.
Complexities and Limitations of Protocols
The study also highlights complexities and limitations inherent in existing protocols. Despite the promising results associated with esketamine, gaps remain in understanding the pharmacodynamics and optimal dosing strategies, especially considering patient demographics such as age and comorbidities. Furthermore, variances in anesthetic techniques during IPE episodes complicate the assessment of esketamine's standalone efficacy.
Conclusion and Future Directions
In conclusion, intravenous esketamine demonstrates a favorable profile for managing IPE in surgical settings, promoting rapid detumescence with minimal adverse effects. The findings reinforce the need for larger, prospective studies to establish standardized treatment protocols and validate esketamine's place within the therapeutic landscape for IPE management, thereby ensuring a systematic, evidence-based approach to improving surgical outcomes.
Key Points
- Intraoperative penile erection (IPE) is a significant complication during urological surgeries, leading to surgical delays and potential erectile dysfunction, necessitating the exploration of non-invasive detumescence methods due to the invasiveness and risks of traditional interventions.
- Esketamine, a non-barbiturate anesthetic with sympathomimetic effects, was evaluated for its efficacy and safety in managing IPE compared to the conventional treatment with ephedrine, with focus on its unique ability to restore sympathetic dominance during anesthesia.
- The retrospective clinical study at Wuhan No.1 Hospital analyzed data from 3,848 urological procedures between January 2021 and December 2023, identifying 37 cases of IPE. Treatment success was defined as the resolution of erection within ten minutes, with esketamine achieving a notably high success rate of 96.3%, versus 80% for ephedrine.
- Data indicated that esketamine facilitated faster detumescence, averaging 3.0 minutes, compared to 5.5 minutes for ephedrine, and this difference was statistically significant, highlighting esketamine's potential advantage in surgical settings.
- Cardiovascular safety assessments reported fewer events such as hypertension and tachycardia with esketamine usage relative to ephedrine. Minor neuropsychiatric effects were observed, but recovery times and postoperative complications showed no significant differences between the two treatment groups.
- Despite promising results with esketamine, the study identified limitations regarding current therapeutic protocols, emphasizing the need for further investigations on pharmacodynamics, dosing strategies, and the implications of patient demographics, alongside recommendations for larger prospective studies to form standardized treatment guidelines for IPE management.
Reference –
Wanjun Yao et al. (2025). Intravenous Esketamine As A Detumescence Agent For Intraoperative Penile Erection During Urological Surgeries: A Retrospective Clinical Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03068-0.
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