Management of pharmacologically induced prolonged penile erection with oral terbutaline in traumatic paraplegics

Intracavernosal administration of papaverine or prostaglandin E1 for erectile impotence in paraplegics is being practised widely. One of the complications of this therapeutic regimen is prolonged erection which is at present being treated by aspiration of corporeal blood and intracavernosal administration of alpha-adrenergic agonist such as phenylephrine. We report successful management of pharmacologically-induced prolonged erection in three traumatic paraplegics with oral terbutaline therapy. The indications for oral terbutaline therapy were (1) absence of significant coronary artery disease and (2) full erection persisting for more than 2 1/2 h, but less than 4 h duration. The initial dose of terbutaline was 5 mg and the same dose was repeated after 15 min as full erection persisted. Within the next 15 min, penile detumescence was achieved in two paraplegics with papaverine-induced prolonged erection. However, full erection still persisted 15 min after the second dose of terbutaline in the third patient who had received intracavernosal administration of 3.25 micrograms of prostaglandin E1. Therefore, he was given the third and final dose of 5 mg of terbutaline under cardiac monitoring. Penile detumescence was achieved within the next 15 min. It was ensured before administration of the third dose of terbutaline that (1) his blood pressure was within the normal range (for his paralysed status), (2) the heart rate was less than 100 per min and (3) there was no cardiac arrhythmia. Occasional premature ventricular contraction was observed only in the patient who received the third dose of terbutaline, but it was transient, self-limiting and did not warrant any treatment.(ABSTRACT TRUNCATED AT 250 WORDS)