Prophylactic Low-Dose Esketamine for Prevention of Intraoperative Penile Erection During Ureteroscopic Surgery Under General Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Trial.
Zijie Zhang, Guojiang Yin, Wanting He et al.
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From the abstract
Intraoperative penile erection (IPE) during ureteroscopic surgery may interrupt surgical procedures and increase the risk of urethral injury. Existing management strategies are largely reactive and frequently require rescue interventions after erection has already developed. Effective prophylactic strategies remain limited.
Reported results
The incidence of IPE was 6.2% (11/178) with esketamine versus 21.9% (39/178) with saline (RR 0.282, 95% CI 0.149-0.533; ARR 15.7%; NNT 6.4; P < 0.001). Porst grades were lower in the esketamine group during disinfection, ureteroscope insertion, and 10 min after surgery commenced, and fewer patients required rescue treatment for clinically significant erection (Porst grade ≥ 2, 4.5% vs 21.3%; P < 0.001).
Authors' conclusions
Prophylactic low-dose esketamine was associated with a lower incidence and severity of intraoperative penile erection, without evidence of impaired postoperative recovery. These findings suggest that prophylactic esketamine may be a useful strategy for preventing this perioperative complication, warranting confirmation in larger multicenter trials.