Malleable Penile Prosthesis Implantation under local anesthesia: Surgical technique and early experience

Mass Lindenbaum, M, Harlamova, D, Werneburg, G, Bajic, P

Erectile dysfunction, Penile Prosthesis, Local Anesthesia.

Penile prosthesis (PP) is the gold-standard therapy for medication-refractory erectile dysfunction (ED) and traditionally is performed under general anesthesia. Subcoronal malleable penile prosthesis (MPP) implantation, which requires minimal dissection, can be performed under local anesthesia, particularly in patients with risk factors for general anesthesia, on anticoagulation therapy or antiplatelet therapy, or with a preference for local anesthesia. We propose a technique of MPP implantation under local anesthesia and present two cases performed at our institution.

We present the surgical technique and two cases of patients who were not candidates for anesthesia, were unable to stop anticoagulation and had long-standing ED refractory to medical therapy. Both patients underwent MPP implantation under local anesthesia at our institution.

The surgical technique and details of the clinical cases are demonstrated in the video.

Both patients received pre-operative analgesia with or without anxiolytic oral medication, an intra-operative block, and post-operative analgesia for two weeks. At 3-month and 1 month post operative follow -up, respectively, both patients reported satisfactory results.

MPP implantation under local anesthesia is a viable and safe option for patients who are unable or unwilling to undergo general anesthesia. Cessation of anticoagulation is not required via the subcoronal approach, and patients can reliably be discharged the same day without risks related to general anesthesia. A larger cohort and multi-center adaption is necessary to finetune an optimal protocol for enhancing the patient experience with these cases

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Petar Bajic, MD – Consultant for Coloplast; Consultant for Boston Scientific; Research funding from Coloplast

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