This document discusses local anaesthesia techniques for common penile procedures. It describes relevant anatomy and different nerve block techniques like the dorsal penile nerve block and intracorpus spongiosal block. It also discusses a transillumination-guided urethral block technique for anterior urethral strictures that has been successfully used in 55 cases without needing additional sedation. The document emphasizes considering local anaesthesia as an option for penile procedures and calculating safe doses to minimize risks.

1. Local Anaesthesia for
Penile Procedures
Dr. F. Brakatu

2. Common Penile Procedures under LA
Urethral catheterization - Intra-urethral local instillation
Circumcision - Penile block + Local Infiltration
Meatotomy - Spongiosal block + Local Infiltration
Dorsal Slit - Penile block + Local Infiltration
Prosthesis Insertion - Crural block + Local Infiltration
Penile Vascular Procedures - Penile block + Local Infiltration

3. Relevant Anatomy

4. Intra-urethral local anaesthetic instillation
Blocks the urethral submucosal plexus
of nerves
For catheterizations and urethroscopies

5. Dorsal Penile Nerve Block

6. Subcutaneous Penile Ring Block

7. DPNB via a Perineal Approach
CB (n=52) vs DPNB (n=52)
No significant difference in
HR & RR
Similar pain scores
Shorter time for 1st
micturition after DPNB than
CB

8. Intracorpus Spongiosal Block

9. Transillumination-guided Urethral Block
For short segment anterior urethral strictures
Blocks cavernosal nerves at proximal (3 & 9 o’clock ) and
distal urethra (12 o’clock)
Feasible for morbid patients unfit for SA or GA who need
DVIU
Simple & Cost-effective
Author has performed 55 DVIUs with this technique
successfully
No conversion to another anaesthesia & no sedation
required
Needs further comparative studies

10. Take Home Message
~ Always Consider LA as an option
~ Always calculate the toxic dose of LA and stay within safe limits
~ LA can complement other methods to decrease analgesic requirement
~ Prepare to complement with IV Sedation if necessary
~ LA may be an option in morbid patients unfit for surgery