Atropine-treated Priapism Following Spinal Anesthesia during Transurethral Resection of a Bladder Tumor : A Case Report

Abstract

Only a few reports describe intraoperative priapism following regional anesthesia. Priapism can occur during transurethral resection of bladder tumors (TUR-Bt), normally in response to difficulty in inserting an urethrocystoscope into the urethra. If this occurs, the planned surgery may be canceled. Therefore, anesthesiologists need to respond rapidly to address this situation. Here we report a case of priapism treated with atropine in a patient undergoing TUR-Bt under spinal anesthesia. A man in his 60s with bladder cancer was scheduled for TUR-Bt. Spinal anesthesia was performed with 0.5% isobaric bupivacaine at the L3-4 space. Immediately after the commencement of the operation, the urologist had difficulty in inserting the urethrocystoscope into the urethra because of priapism. The priapism was resolved by atropine, and the operation was resumed. Intraoperative priapism appears to be a reflex mediated by local stimulation of the penis. Although the specific mechanisms responsible for priapism remain unclear, our case suggests that atropine can resolve priapism by inhibiting the sacral spinal cord parasympathetic pathway.