Subcoronal IPP Under Local Anesthesia with Modified Wilson's Deaver Maneuver

Sung Hun Park

Objective: To demonstrate first time inflatable penile prosthesis surgery via subcoronal approach under local anesthesia with modified Wilson’s deaver maneuver

Material: 64 years old Korean man with medicine non-responsive ED had first time inflatable penile prosthesis surgery under local anesthesia in Apr. 28th, 2016

Methods: 0.2cc Trimix was injected preoperatively to relax corporal muscle. Local anesthesia was done on 6 sites; 3 blocks right before the surgery: Pudendal, Penile root, Rt. Inguinal canal and 3 sites during the course of the surgery: Each anterior proximal corporal space, scrotal septum, each proximal corpora. Foley catheter was placed. Through subcoronal incision, atraumatic penile degloving was done. Scrotal septum was dissected with modified Wilson’s deaver maneuver to prevent postop tail pipe penis. Corporal length was measure as 22 cm. After placing 125cc reservoir with 100cc filling on Rt. Retzius space, 22cm Coloplast Titan Touch cylinders were placed. Penile skin was repaired in 2 layers with continuous suture. Compression dressing was applied.

Results: Total 32cc of 1% lidocaine & 0.5% bupivacaine mixture was injected. Subjective pain scale during the surgery was 2. OR time was 48 minutes. Preoperative penile stretch length was 12.5cm and 13.1cm postoperatively. There was neither postoperative hematoma nor tubing protrusion. Patient was able to cycle the pump 2 weeks after the surgery.

Conclusion: Subcoronal IPP placement under local anesthesia could be done with minimal patient discomfort with organized injections. Modified Wilson’s deaver maneuver seems to be effective on preventing tail pipe penis with subcoronal approach.