Persistent Penile Erection Following Spinal or General Anesthesia During Pediatric Hypospadias Repair: A Case Report

Penile erection (PE) during anesthesia is a rare yet challenging complication, particularly in pediatric patients undergoing urological surgeries such as hypospadias repair. This case report presents the management of a persistent PE in a 13-year-old male during stage II hypospadias repair under spinal anesthesia, which was subsequently switched to general anesthesia due to the failure of initial interventions. Despite attempts to resolve the erection using intravenous glycopyrrolate, ketamine, cold compresses, blood aspiration, muscle relaxation under general anesthesia, and dorsal penile nerve block, detumescence was not achieved. Finally, the administration of an intracavernous injection of phenylephrine resulted in complete detumescence, allowing the surgery to proceed without further complications. Therefore, this case highlights the early and firsthand use of intracavernous phenylephrine as a safe, simple, and effective method for managing persistent PE in pediatric surgical patients. It also underscores the importance of being prepared and adaptable when handling rare intraoperative complications during pediatric surgeries.