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Received: June 19, 2018; Accepted: July 3, 2018; Published: July 30, 2018
Abstract: It is a common observation that following spinal anaesthesia, the penis usually elongates. The aim of this study
was to determine the degree of change in penile length following spinal anaesthesia. Consecutive urosurgical patients
undergoing spinal anaesthesia were recruited for this study. Those who received general anaesthesia or incomplete spinal
blocked were also excluded. The flaccid length of the penis was measured before and after the administration of spinal
anaesthesia. Penile length 15 minutes post-spinal anaesthesia was measured and recorded. The change in length was tested for
statistical significant difference, the age of patient; diagnosis and type of surgery were also recorded. Forty three patients
completed the study. Benign prostatic hypertrophy constituted 41.9% of the surgical indications. While 53.5% of the patients
were ASA I, 39.5% and 7.0% of them were ASA II and III respectively. While the mean initial penile length was 12.1 ± 0.53
cm and the mean final length was 15.7 ± 0.53 cm, the mean maximal change in penile length was 3.6±1.5 cm; p<0.0001. There
was no statistical correlation between age and mean differential change in length of penis (r= -0.2842, p=0.43). It was therefore
concluded that there was a significant change in penile length (tumescence) following successful spinal anaesthesia.
Keywords: Spinal Anaesthesia, Flaccid, Penile Length, Tumescence, Urologic Surgery
1. Introduction
Intraoperative penile tumescence is very frequent in males urethral trauma could arise and surgery has to be delayed
undergoing surgical procedures under regional anaesthesia. until successful detumescence or rescheduled to a later date.
This change in penile length can pose a challenge to the The term ‘tumescence’ may be appropriately used in this
attending urologist. The aetiology of tumescence following index study to describe this phenomenon of painless penile
spinal anaesthesia is still nebulous. It is frequently thought erection during anaesthesia as this is usually short lived.
that mechanism of tumescence involves the arterioles, Unlike priapism which could be defined as a persistent
venules, and arterovenous anastomotic channels of the painful penile erection unaccompanied by desire or sexual
corpora cavernosa.[1, 2] In the flaccid state, the arterioles are excitement and/or arousal. It is well-known that priapism
partially closed while the venules and arteriovenous channels sustained for a long time (usually more than 4 hours) may
remain open, providing an unimpeded drainage of the arterial result in oedema, increased risk of abrasion, tissue drying,
inflow. and necrosis of the penis, with the prognosis, in general,
However, penile engorgement can result in partial or total depending on the type of priapism and the amount of time
tumescence at the time of both urologic and non-urologic elapsed before the therapeutic intervention.
surgeries. It could be challenging to perform the some The aim of this study was determine the degree of change
urologic procedures especially transurethral resection of the in penile length frequently observed in our routine urologic
prostate (TURP) during penile erection as this could render surgeries and compare its relationship with age of the adult
the urethroscope an inappropriate length for the erected penis males.
and other complications such as excessive bleeding and
Journal of Anesthesiology 2018; 6(1): 40-44 41
Table 2. Indications for surgery. mmHg respectively. The mean SPO2 was 97±1.24%.
Indication Number Percent (%)
Table 3. Block characteristics and mean haemodynamic variables.
Benign Prostate Hyperplasia 18 41.9
Urethral stricture 9 20.9 Maximal height of block T10
Cancer of prostate 3 7.0 Maximal modified Bromage score* B1
Cystitis 2 4.7 Mean SPO2 (%) 97±1.24
Bladder neck stenosis 5 11.6 Mean Systolic blood pressure (mmHg) 128±15
Hernia 1 2.3 Mean Diastolic blood pressure (mmHg) 60±23
Scrotal lipoma 1 2.3 Mean mean arterial blood pressure (mmHg) 75±18
Bladder cancer 1 2.3
Testicular torsion 1 2.3 *Modified Bromage score by Breen et al2.
Bladder stone 1 2.3
Varicocoele 1 2.3 Table 4 shows the change in penile length during tumescence.
While the mean initial penile length was 12.1±0.53 cm and the
Table 3 shows the block characteristics and the mean mean final length was 15.7±0.53 cm, the mean maximal change
haemodynamic variables. The maximal height of motor block in penile length was 3.6±1.5 cm; p<0.0001. There was no
was T10 while the maximal attained motor block was modified statistical correlation between age and mean differential change
Bromage B1. The mean systolic, diastolic and mean arterial in length of penis (r= -0.2842, p=0.43).
blood pressures were 128±15 mmHg, 60±23 mmHg and 75±18
Table 4. Preanaesthetic and post anaesthetic penile length.
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Conflict of Interest Giannakis DJ, Sofikitis NV, Charalabopoulos KA. Penile
erection during transurethral surgery. J Androl 2006; 27: 376-
The authors declare that they have no competing interests. 380.
[10] Rao TH, Zaman W, Jain RK. Intraoperative penile erection.
Arch Esp Urol. 2000; 53: 953-956.
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