Evaluation of the Effectiveness of Local Anesthesia and Patient Tolerance in Penile Prosthesis Implantation
Öz
Objective: This study aims to evaluate the effectiveness, safety, and patient tolerance of penile prosthesis implantation (PPI) performed under local anesthesia (LA). The study investigates its impact on perioperative pain management, postoperative recovery, and overall patient satisfaction.
Material and Methods: This prospective study included 26 male patients who underwent PPI under LA between January 2024 and December 2024. Ethical approval was obtained from the Ethics Committee Antalya Training and Research Hospital No: 2/24, Date: 30.01.2025). Pain intensity was assessed using the Visual Analog Scale (VAS), while patient stability and intraoperative parameters were monitored. The American Society of Anesthesiologists (ASA) classification system was used for anesthesia risk assessment.
Results: The mean age of the patients was 67.25 ± 11.48 years. Diabetes mellitus and hypertension were present in 75% and 62.5% of patients, respectively. According to ASA classification, 46.2% were classified as ASA-II, while 53.8% were ASA-III. The mean intraoperative VAS score was 1.8 (mild pain), while the mean postoperative VAS score was 4.6 (mild-to-moderate pain). No patients required additional sedation or conversion to general anesthesia. No major intraoperative complications or postoperative prosthesis-related complications were observed.
Conclusion: Local anesthesia is a feasible and effective alternative for penile prosthesis implantation, offering benefits such as minimal intraoperative discomfort, avoidance of systemic anesthetic complications, and a favorable recovery profile. Further studies with larger cohorts are needed to optimize pain management strategies and evaluate long-term functional outcomes.
Anahtar Kelimeler
Penile prosthesis implantation Local anesthesia Erectile dysfunction Pain management
Kaynakça
- 1. Haensch, C. A., Hilz, M., Jost, W., Kaufmann, A., Kessler, T., & Lahrmann, H. (2019). S1-Leitlinie Diagnostik und Therapie der erektilen Dysfunktion [S1-Guideline for Diagnosis and Treatment of Erectile Dysfunction]. Fortschritte der Neurologie · Psychiatrie, 87(4), 225-233. https://doi.org/10.1055/a-0747-5892
- 2. Goldstein, I., Goren, A., Li, V. W., Tang, W. Y., & Hassan, T. A. (2020). Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sexual medicine reviews, 8(1), 48–58. https://doi.org/10.1016/j.sxmr.2019.06.008
- 3. Kessler, A., Sollie, S., Challacombe, B., Briggs, K., & Van Hemelrijck, M. (2019). The global prevalence of erectile dysfunction: a review. BJU international, 124(4), 587–599. https://doi.org/10.1111/bju.14813
- 4. Porst, H., Burnett, A., Brock, G., Ghanem, H., Giuliano, F., Glina, S., Hellstrom, W., Martin-Morales, A., Salonia, A., & Sharlip, I. (2013). SOP conservative (medical and mechanical) treatment of erectile dysfunction. Journal of Sexual Medicine, 10(1), 130-171. https://doi.org/10.1111/jsm.12023
- 5. Fidel, M. G., Shah, J., Bal, D. S., Roque, C., Ko, Y., Dhillon, H., Bard, R., Pandian, A., Nayak, J. G., & Patel, P. (2024). Inflatable penile prosthesis implantation in the outpatient setting is safe and feasible: a prospective, singe center study. International journal of impotence research, 10.1038/s41443-024-01004-3. Advance online publication. https://doi.org/10.1038/s41443-024-01004-3
- 6. Elatreisy, A., Ahmed, Y., Elgarhy, A., Hindawy, M., Abouelgreed, T., Ahmed, I., et al.(2024). Comparative study between intrathecal fentanyl and dorsal penile nerve block for controlling postoperative pain after inflatable penile prosthesis implantation. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 96(4), 12951. https://doi.org/10.4081/aiua.2024.12951
- 7. Lucas, J., Gross, M., Yafi, F., DeLay, K., Christianson, S., El-Khatib, F. M., Osman, M., & Simhan, J. (2020). A Multiinstitutional Assessment of Multimodal Analgesia in Penile Implant Recipients Demonstrates Dramatic Reduction in Pain Scores and Narcotic Usage. The journal of sexual medicine, 17(3), 518–525. https://doi.org/10.1016/j. jsxm.2019.11.267
- 8. Klimek, L., Bergmann, K. C., Biedermann, T., Bousquet, J., Hellings, P., Jung, K., Merk, H., Olze, H., Schlenter, W., Stock, P., Ring, J., Wagenmann, M., Wehrmann, W., Mösges, R., & Pfaar, O. (2017). Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care. Allergo Journal International, 26(1), 16-24. https://doi.org/10.1007/s40629-016-0006-7
- 9. American Society of Anesthesiologists. (2014). ASA Physical Status Classification System. Retrieved from https:// www.asahq.org/resources/clinical-information/asa-physical-status-classification-system
- 10. American Society of Anesthesiologists. (2012). Practice Guidelines for Preoperative Assessment. Anesthesiology.
- 11. Cherobin, A. C. F. P., & Tavares, G. T. (2020). Safety of local anesthetics. Anais Brasileiros de Dermatologia, 95(1), 82-90. https://doi.org/10.1016/j.abd.2019.09.025
- 12. Schnabl, S. M., Herrmann, N., Wilder, D., Breuninger, H., & Häfner, H. M. (2014). Clinical results for use of local anesthesia with epinephrine in penile nerve block. Journal of the German Society of Dermatology, 12(4), 332-339. https://doi.org/10.1111/ddg.12287
- 13. Hsu GL, Hsieh CH, Chen HS, Ling PY, Wen HS, Liu LJ, Chen CW, Chua C. The advancement of pure local anesthesia for penile surgeries: can an outpatient basis be sustainable? J Androl. 2007 Jan-Feb;28(1):200-5. https://doi. org/10.2164/jandrol.106.000679. Epub 2006 Sep 20. PMID: 16988329.
- 14. Althof, S. E., et al. (2014). An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). The Journal of Sexual Medicine, 11(6), 1392-1422.
- 15. Brennan, F., Carr, D. B., & Cousins, M. (2007). Pain management: A fundamental human right. Anesthesia & Analgesia, 105(1), 205-221. https://doi.org/10.1213/01.ane.0000268145.52345.55
- 16. Altieri, V. M., Saldutto, P., Verratti, V., La Rocca, R., Di Mauro, E., Celentano, G., Capece, M., Morgera, V., Cacace, G., Vena, W., Mastrangelo, F., Napolitano, L., & Iacono, F. (2024). Altieri modified Nesbit corporoplasty for thetreatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes. Archivio Italiano di Urologia e Andrologia, 96(4), 12957. https://doi.org/10.4081/aiua.2024.12957
- 17. Reinstatler, L., Shee, K., & Gross, M. S. (2018). Pain management in penile prosthetic surgery: A review of the literature. Sexual Medicine Reviews, 6(1), 162-169. https://doi.org/10.1016/j.sxmr.2017.05.005
- 18. Hellstrom W. J. G. (2025). Advances in penile prosthetics: current trends and future directions in erectile dysfunction treatment. International journal of impotence research, 37(1), 1–3. https://doi.org/10.1038/s41443- 024-01010-5
Penil Protez İmplantasyonunda Lokal Anestezinin Etkinliğinin ve Hasta Toleransının Değerlendirilmesi
Öz
Amaç: Bu çalışmanın amacı, lokal anestezi altında gerçekleştirilen penis protezi implantasyonunun (PPI) etkinliğini, güvenliğini ve hasta toleransını değerlendirmektir. Çalışma, perioperatif ağrı yönetimi, postoperatif iyileşme süreci ve genel hasta memnuniyeti üzerindeki etkilerini araştırmaktadır.
Gereç ve Yöntemler: Bu prospektif çalışmaya, Ocak 2024 ile Aralık 2024 tarihleri arasında lokal anestezi altında PPI uygulanan 26 erkek hasta dahil edildi. Çalışma için etik onay, Antalya Eğitim ve Araştırma Hastanesi Etik Kurulu’ndan alındı (Karar No: 2/24, Tarih: 30.01.2025). Ağrı şiddeti Görsel Analog Skalası (VAS) kullanılarak değerlendirildi ve intraoperatif parametreler ile hasta stabilitesi takip edildi. Anestezi riski değerlendirmesinde Amerikan Anesteziyologlar Derneği (ASA) sınıflandırma sistemi kullanıldı.
Bulgular: Hastaların ortalama yaşı 67,25 ± 11,48 yıl olup, %75’inde diyabetes mellitus, %62,5’inde hipertansiyon mevcuttu. ASA sınıflandırmasına göre hastaların %46,2’si ASA-II, %53,8’i ASA-III kategorisinde yer aldı. Ortalama intraoperatif VAS skoru 1,8 (hafif ağrı), ortalama postoperatif VAS skoru ise 4,6 (hafif-orta şiddette ağrı) olarak ölçüldü. Hiçbir hastada ek sedasyon gereksinimi ya da genel anesteziye geçiş ihtiyacı oluşmadı. Ayrıca, intraoperatif veya erken postoperatif dönemde ciddi komplikasyon veya protezle ilişkili olumsuz durum gözlenmedi.
Sonuç: Lokal anestezi, penis protezi implantasyonu için güvenilir ve etkili bir alternatif olup, minimal intraoperatif rahatsızlık, sistemik anestezik komplikasyonlardan kaçınma ve avantajlı bir iyileşme süreci sunmaktadır. Daha geniş hasta gruplarında yapılacak ileri çalışmalar, ağrı yönetimi stratejilerinin optimize edilmesi ve uzun dönem fonksiyonel sonuçların değerlendirilmesi açısından gereklidir.
Anahtar Kelimeler
Penis protezi implantasyonu Lokal anestezi Erektil disfonksiyon Ağrı yönetimi
Etik Beyan
Received by the Health Sciences University Antalya Training and Research Hospital Clinical Research Ethics Committee (Decision No: 2/24, Date: 30.01.2025).
Destekleyen Kurum
No financial support was used in this study.
Kaynakça
- 1. Haensch, C. A., Hilz, M., Jost, W., Kaufmann, A., Kessler, T., & Lahrmann, H. (2019). S1-Leitlinie Diagnostik und Therapie der erektilen Dysfunktion [S1-Guideline for Diagnosis and Treatment of Erectile Dysfunction]. Fortschritte der Neurologie · Psychiatrie, 87(4), 225-233. https://doi.org/10.1055/a-0747-5892
- 2. Goldstein, I., Goren, A., Li, V. W., Tang, W. Y., & Hassan, T. A. (2020). Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sexual medicine reviews, 8(1), 48–58. https://doi.org/10.1016/j.sxmr.2019.06.008
- 3. Kessler, A., Sollie, S., Challacombe, B., Briggs, K., & Van Hemelrijck, M. (2019). The global prevalence of erectile dysfunction: a review. BJU international, 124(4), 587–599. https://doi.org/10.1111/bju.14813
- 4. Porst, H., Burnett, A., Brock, G., Ghanem, H., Giuliano, F., Glina, S., Hellstrom, W., Martin-Morales, A., Salonia, A., & Sharlip, I. (2013). SOP conservative (medical and mechanical) treatment of erectile dysfunction. Journal of Sexual Medicine, 10(1), 130-171. https://doi.org/10.1111/jsm.12023
- 5. Fidel, M. G., Shah, J., Bal, D. S., Roque, C., Ko, Y., Dhillon, H., Bard, R., Pandian, A., Nayak, J. G., & Patel, P. (2024). Inflatable penile prosthesis implantation in the outpatient setting is safe and feasible: a prospective, singe center study. International journal of impotence research, 10.1038/s41443-024-01004-3. Advance online publication. https://doi.org/10.1038/s41443-024-01004-3
- 6. Elatreisy, A., Ahmed, Y., Elgarhy, A., Hindawy, M., Abouelgreed, T., Ahmed, I., et al.(2024). Comparative study between intrathecal fentanyl and dorsal penile nerve block for controlling postoperative pain after inflatable penile prosthesis implantation. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 96(4), 12951. https://doi.org/10.4081/aiua.2024.12951
- 7. Lucas, J., Gross, M., Yafi, F., DeLay, K., Christianson, S., El-Khatib, F. M., Osman, M., & Simhan, J. (2020). A Multiinstitutional Assessment of Multimodal Analgesia in Penile Implant Recipients Demonstrates Dramatic Reduction in Pain Scores and Narcotic Usage. The journal of sexual medicine, 17(3), 518–525. https://doi.org/10.1016/j. jsxm.2019.11.267
- 8. Klimek, L., Bergmann, K. C., Biedermann, T., Bousquet, J., Hellings, P., Jung, K., Merk, H., Olze, H., Schlenter, W., Stock, P., Ring, J., Wagenmann, M., Wehrmann, W., Mösges, R., & Pfaar, O. (2017). Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care. Allergo Journal International, 26(1), 16-24. https://doi.org/10.1007/s40629-016-0006-7
- 9. American Society of Anesthesiologists. (2014). ASA Physical Status Classification System. Retrieved from https:// www.asahq.org/resources/clinical-information/asa-physical-status-classification-system
- 10. American Society of Anesthesiologists. (2012). Practice Guidelines for Preoperative Assessment. Anesthesiology.
- 11. Cherobin, A. C. F. P., & Tavares, G. T. (2020). Safety of local anesthetics. Anais Brasileiros de Dermatologia, 95(1), 82-90. https://doi.org/10.1016/j.abd.2019.09.025
- 12. Schnabl, S. M., Herrmann, N., Wilder, D., Breuninger, H., & Häfner, H. M. (2014). Clinical results for use of local anesthesia with epinephrine in penile nerve block. Journal of the German Society of Dermatology, 12(4), 332-339. https://doi.org/10.1111/ddg.12287
- 13. Hsu GL, Hsieh CH, Chen HS, Ling PY, Wen HS, Liu LJ, Chen CW, Chua C. The advancement of pure local anesthesia for penile surgeries: can an outpatient basis be sustainable? J Androl. 2007 Jan-Feb;28(1):200-5. https://doi. org/10.2164/jandrol.106.000679. Epub 2006 Sep 20. PMID: 16988329.
- 14. Althof, S. E., et al. (2014). An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). The Journal of Sexual Medicine, 11(6), 1392-1422.
- 15. Brennan, F., Carr, D. B., & Cousins, M. (2007). Pain management: A fundamental human right. Anesthesia & Analgesia, 105(1), 205-221. https://doi.org/10.1213/01.ane.0000268145.52345.55
- 16. Altieri, V. M., Saldutto, P., Verratti, V., La Rocca, R., Di Mauro, E., Celentano, G., Capece, M., Morgera, V., Cacace, G., Vena, W., Mastrangelo, F., Napolitano, L., & Iacono, F. (2024). Altieri modified Nesbit corporoplasty for thetreatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes. Archivio Italiano di Urologia e Andrologia, 96(4), 12957. https://doi.org/10.4081/aiua.2024.12957
- 17. Reinstatler, L., Shee, K., & Gross, M. S. (2018). Pain management in penile prosthetic surgery: A review of the literature. Sexual Medicine Reviews, 6(1), 162-169. https://doi.org/10.1016/j.sxmr.2017.05.005
- 18. Hellstrom W. J. G. (2025). Advances in penile prosthetics: current trends and future directions in erectile dysfunction treatment. International journal of impotence research, 37(1), 1–3. https://doi.org/10.1038/s41443- 024-01010-5
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Üroloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Mayıs 2025 |
| Gönderilme Tarihi | 2 Mart 2025 |
| Kabul Tarihi | 4 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 17 Sayı: 2 |
