Safety and effectiveness of a modified technique for three-piece inflatable penile prosthesis implantation under local anesthesia with a minimal scrotal incision (Wang’s incision) in the treatment of erectile dysfunction

Background: Erectile dysfunction (ED) is a common disorder in adult males that can seriously affect quality of life. For patients with moderate-to-severe ED who are unresponsive to first- or second-line treatments [e.g., oral phosphodiesterase type 5 (PDE5) inhibitors], penile prosthesis implantation (PPI) is the definitive treatment recommended by international guidelines. Conventional PPI is usually performed under general or spinal anesthesia and requires a relatively long incision, resulting in substantial trauma. Consequently, it may not be suitable for elderly patients or those with underlying comorbidities. The present study was designed to evaluate the safety, feasibility, and clinical effectiveness of a modified technique for three-piece inflatable penile prosthesis (IPP) implantation under local anesthesia with a minimal scrotal incision, which we term Wang’s incision.

Methods: A retrospective analysis was conducted on 220 patients who underwent AMS 700TM three-piece IPP implantation between January 2022 and December 2025 and completed the 2-year postoperative follow-up. Patients were divided into a control group (n=118, general/spinal anesthesia) and a modified group (n=102, local anesthesia with Wang’s incision). Perioperative parameters, pain scores [based on the Numeric Rating Scale (NRS)], erectile function, and patient satisfaction were compared between the groups.

Results: The modified group showed significantly shorter cylinder placement time, total operative time, and incision length compared to the control group (all P<0.01). Intraoperative pain scores remained within the tolerable range, peaking during reservoir placement (4.51±1.72). Both groups demonstrated significant improvements in erectile function and patient satisfaction postoperatively (both P<0.01), with no significant intergroup differences observed. In the modified group, no cases required conversion to general or spinal anesthesia, and no serious complications occurred.

Conclusions: The modified local anesthesia technique with Wang’s incision is safe and effective for three-piece IPP implantation. It has several advantages, including minimal invasiveness, short operative time, rapid recovery, and improved cosmesis, making it particularly suitable for elderly patients or those with comorbidities who are unfit for general or spinal anesthesia.