AB175. Three-piece penile prosthesis implantation under local anesthesia

Introduction: Malleable penile prosthesis could be inserted by local anesthesia only, but there are few reports available regarding 3-piece penile prosthesis implantation under local anesthesia due to some difficulty in inserting reservoir. It would be very advantageous if 3-piece penile prosthesis could be implanted by local anesthesia only at private clinic as a one stop service. The authors developed a local anesthetic method that could implant 3-piece penile prosthesis easily as a day surgery at private clinic.

Material and methods: A total of 45 cases (38 fresh, 7 revision) were implanted under local anesthesia from Oct 2013 to Jul 2014.

Methods of local anesthesia: (I) Premedication--alprazolam 0.25 mg po; (II) IV fluid and monitoring pulse and po2; (III) tramadol hcl 50 mg 1 or 2 ampl iv; (IV) midazolam 1 or 2 mg iv; (V) pudendal n block 1.5% lidocaine 5 cc instill on both side each; (VI) ilioinguinal n block—1.5% lidocaine 5 cc; (VII) penile block dorsal n and scrotal skin—1% lidocaine.

Results: A total of 45 patients (38 fresh, 7 revision) completed the study. The mean age of the patients was 62 years (range, 35 to 81 years). The types of implanted prosthesis were AMS CXR 35 and CX 10. The length of implanted prosthesis was from 14 to 20 cm (mean 16 cm). The response during surgery estimated by three grades: (I) very comfortable and smooth, no pain complaint at all (30 patients); (II) mild pain sometimes but well tolerated (13 patients); (III) marked pain and screaming (2 patients). Malignant tachycardia was observed in one case. No case was converted to general anesthesia. Barovac drainwas removed between 24 to 48 hours. Patients were discharged on that day (15 patients) or next day (30 patients).

Conclusions: Three-piece penile prosthesis could be implanted easily under local anesthesia as a one stop service at private clinic.

Keywords: Penile prosthesis implantation; local anesthesia