First time inflatable penile prostheses performed under local anesthesia: a single surgeon series suggests ways to improve both the patient and surgeon experience

After its first introduction in 1982, studies have shown that performing inflatable penile prosthesis (IPP) under local anesthesia (LA) is not only feasible but additionally provides postoperative analgesia. In our retrospective review of 1334 first-time IPP under LA between 2014 and 2024, mean injected volume of anesthetic drug was 36.5 mL. Additional conscious sedation was required in 433 patients (31.7%), and none underwent conversion to regional or general anesthesia intraoperatively. Notably, all ectopic reservoir placement (n = 184) required additional conscious sedation. Mild local anesthesia systemic toxicity (LAST) was reported in 82 cases (6.2%) which was managed with conservative treatment. In 2 patients who experienced moderate LAST, IV benzodiazepine neutralized the neurologic symptoms. Two stages of an injection was done with 1:1 mixture of 1% lidocaine and 0.75% ropivacaine through a 10 mL syringe with a 25 G 1.5-inch needle. LA also seems to provide better postoperative pain control by continuation of analgesia beyond normal half-life of the injected drugs. It also gives valuable prompts for individualized pain management post operatively. Finally, it may help detection of an intraoperative complication by utilizing sudden pain as a safety marker.