İntrakavernöz enjeksiyon tedavisinin komplikasyonu olarak penis içinde kırılmış iğne

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Introduction
A number of agents, either alone
or in combination, have long been
used in erectile dysfunction for intracavernous injection therapy; though
this was not without serious adverse
effects such as priapism, corporeal
fibrosis, systemic side effects due to
vasodilatory action (e.g. hypotension,
tachycardia, pallor, dizziness), painful
erection, pain in the injection site and
hematoma/ecchymosis (1). Rather
high patient drop out rates have also
been reported due to various reasons
such as unnaturalness of the treatment, and the above-mentioned adverse effects associated with the procedure (1). We herein report a rather
unusual complication of intracavernous injection therapy.Cilt 49 · Sayý 1 · Gülhane TD Broken needle in the penis · 41
to obstruct urine flow and this was
removed on the next day. After one
week, there was no hematoma nor
active bleeding at the surgery site.
The patient was advised to switch to
oral medication.
Discussion
The advent of phosphodiesterase
(PDE) inhibitors has cut down on the
prescription of intracavernous injection therapy and gained popularity
rapidly. However PDE inhibitors are
often not covered by insurance policies as opposed to less expensive
alternative agents used for ICIT. On
the other hand, ICIT, being a rather
invasive procedure, requires manual
dexterity. Our case got his prescription elsewhere and was from a lower
sociocultural level. The attending
physician might have chosen injection therapy as the firstline treatment
due to the above-mentioned economical concerns, yet underestimating the importance of patient capability before starting such a treatment.
The oblique needle track in the longitudinal direction suggested that the
patient's injection technique was
wrong. We figured that he inserted
the needle obliquely causing it to
travel within the corpus cavernosum
more than needed, and after completing the injection, he pulled the
syringe back in an improper direction
which exerted a bending force on the
needle which caused it to break
before it came out of the penis.
Needle breakage is a very rare
complication of ICIT and there are a
few case reports in the literature (2-
6). It appears that broken part of the
needle may be deep inside of the corpus cavernosum, and one may not be
able to feel and remove it at first;
however, needle may be found at a
more superficial location and may be
removed later on (2).
As a conclusion, whenever an
ICIT is to be started in a patient with
ED, manual dexterity should be considered in the first place and the
importance of the correct injection
technique must be stressed.