Inflatable penile prosthesis surgery can be performed safely and with good patient acceptance under local anesthesia in a free-standing clinic
Park, SH1; Lee, KB1; Choo, SH2; Wilson, SK3
1: Sewum Prosthetic Urology Center of Excellence, Seoul, Korea; 2: Department of Urology, Ajou University School of Medicine, Suwon, Korea; 3: Institute for Urologic Excellence, CA, USA
Objective: For more than 40 years, 3-piece inflatable penile prosthesis (IPP) has been done under general or regional anesthesia. To provide more safety in the free-standing clinic location, we have developed a method of local anesthesia when performing IPP. We desire to report our experiences of a large cohort of Asian men.
Material & Methods: 502 consecutive patients had IPP surgeries 2/2014 to 6/2017 by a single surgeon were analyzed retrospectively. Injection of local anesthesia (1% lidocaine, 0.5% bupivacaine 50:50) was used in the following sequential steps
- Pethidine 25mg before shaving
- Bilateral pudendal block, a direct inguinal block & penile root block
- Scrotal approach: injection on scrotal wall where incision will be made.
- Subcoronal approach: After degloving the penis to penoscrotal junction, proximal corpora injected just before the corporal incision.
- Additional inguinal injection of local may also be done if pain encountered during reservoir placement. To prevent over dosage, 35 ml was maximum volume of anesthetic injection.
Results: 478 were virgin cases and 24 were reoperation cases (infection 4, mechanical failure 12). Mean OR time was 55 ± 18 min, Mean total volume of anesthetic injection was 30 ± 4.5 ml. 178 (35.5%) patients had additional conscious sedation with either Etomidate (156) or Propofol (22). Scrotal approach was used to 133 patients and 369 patients had surgery via subcoronal incision. Reservoir was placed to Space of Retzius in 447 cases, 55 cases had high submuscular placement. All patients who had high submuscular placement required conscious sedation. During the surgery, 3 had transient hypotension which recovered spontaneously with reverse Trendelenberg position & IV fluid infusion. Mean pain scale during the surgery was 4.7 and the next day of surgery was 2.9. Only 21 (4.2%) patients required an opioid for pain relief after the surgery. During mean 21 months (3 to 44 months) follow up, our complications were 6 infections (1.19%) and 6 mechanical failures.
Conclusion: Inflatable penile prosthesis surgery can be performed under local anesthesia with acceptable patient tolerance.
Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.Go Back