Intracorporeal Needle Breakage During Intracavernous Injection Therapy: a Case Report
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SURGERY
Intracorporeal Needle Breakage During Intracavernous Injection Therapy: a Case Report Bernardo Gabriele Collaço 1
&
Milena Da Silveira Cavalcante 1 & Eduardo P. Miranda 1 & Ariel Gustavo Scafuri 1
Accepted: 20 August 2020 # Springer Nature Switzerland AG 2020
Abstract Intracavernous injection (ICI) therapy is an effective treatment for erectile dysfunction (ED) that has been used since 1982. Intracorporeal needle breakage is a rare complication of this procedure, with a few case reports in the literature. Thus, we present a case of a 54-year-old man with needle breakage during routine application. The precise location of the needle was confirmed by radiography and ultrasonography. This patient was successfully treated with surgical exploration and needle withdrawal. No postoperative complication was reported and he maintained his usual response to intracavernous vasoactive agents. Although rare, it can be solved with immediate surgical exploration with no long-term complications. Keywords Intracavernous injection . Needle . Breakage . Erectile dysfunction
Introduction Although ICI therapy has been used since 1982 as an effective erectile dysfunction (ED) treatment, some complications are reported, such as penile pain, priapism, fibrosis, and bruising [1]. Intracorporeal needle breakage is a rare adverse event with only eight cases reported in the literature [1–3]. There are different approaches to such medical problems including conservative treatment, ultrasound-guided procedures, and surgical exploration [1–8]. Therefore, we report a case of a retained needle in the penis that was successfully treated with surgical exploration. In addition, we performed a brief literature review highlighting the importance of patent education during intracavernous injection (ICI) treatment and alternative ways to solve this inconvenient situation.
Case Report
3 years because of intolerable headache following on-demand phosphodiesterase type 5 inhibitors (PDE5i) use. Additionally, the patient was uncircumcised and referred to redundant foreskin associated with recurrent balanitis. He denied any history of previous surgical interventions. During the examination, the needle was neither visually perceptible nor palpable. Radiography and ultrasound scanning was performed and allowed the identification of a metallic image inside the left cavernosal body (Figs. 1 and 2). After discussing the option with the patient, surgical exploration was indicated. Through a subcoronal approach, Buck’s fascia was incised and dissected. The tiny needle dimensions (0.7 cm) made it difficult to identify the exact location. However, during palpation, the tip of the needle was felt and it was successfully removed (Figs. 3 and 4). The patient reported no worsening of his erectile function, maintaining his regular ability to have intercourse using ICI and no need for dose adjustment. After recovery from surgery, the patient was retrained on intracavernous self-injection to avoid recurrence or further complications.
A 54-year-old man with ED
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