Subcoronal inflatable penile prosthesis under local anesthesia

Utilizing local anesthesia (LA) with inflatable penile prosthesis (IPP) surgery is getting more attention worldwide due to its favorable effect on postoperative pain control and cost effectiveness in patients without third party coverage. From Jan 2015 to Dec 2018, we have performed subcoronal incision under LA in 557 first time IPP patients and 84 cases (15%) required additional sedation particularly for reservoir placement. Compared to infrapubic and penoscrotal incisions, subcoronal approach seems to be particularly suited to LA because of unhampered visual field after the anesthetic injection. LA was achieved with 1% lidocaine & 0.75% ropivacaine mixture injected through 10 cc syringe with 25G, 1.5-inch needle. Two injections were done; one before the incision and one following penile degloving. The patient’s skin is prepped with Chlorhexidine while patient is in the frog leg position; the frog leg position is maintained for the preoperative block consisting of bilateral pudendal blocks, penile root blocks & direct inguinal block on the side utilized for reservoir placement. 25 cc of the anesthetic mixture is consumed by these injections. After circumcision incision and penile degloving, we inject the following intraoperative sites: each anterior area of proximal corpora, scrotal septum, and each corpus where incision will be made. If inguinal block was uncertain, additional anesthetic injection under direct vision while inguinal ring is retracted. Mean patient pain scale on local anesthesia was 2.74 and following the surgery was 4.24. Conscious sedation was used as a supplement in 84 cases (15%). There was no case of conversion to spinal or general anesthesia and 485 patients (87%) said that they would have IPP surgery again under local anesthesia. We firmly believe IPP Placement via subcoronal incision under local anesthesia can be done to first time implant patient cost effectively and with acceptable patient discomfort.