Have the patient undress from the waist down and place patient supine on examination table with a sheet covering them. Optional: If using local anesthetic, this should be given as a penile block at the base of the penis as described in Chap. 4. Allow 5–10 min for the block to be effective.

The point of maximal curvature which was determined during a prior curvature assessment should be marked as the location for injection (Fig. 11.2). The injection should only be performed on a flaccid penis . If using an assistant, have them stretch the penis as you get a good grip on the plaque (Fig. 11.3). Use an antiseptic wipe to prepare the skin prior to injection and allow skin to dry. While wearing gloves, insert the needle into the marked location going transversely into the side of the plaque but not completely through the other side (Figs. 11.4 and 11.5). You should feel resistance while inserting the needle due to the dense plaque tissue. Slowly depress the plunger to dispense the medication and slowly withdraw the needle back through the plaque (Fig. 11.6). You should note there is also resistance to the dispersion of medication. Once the medication is fully delivered, the needle can be removed and secured. The goal is to dispense all of the medication within the plaque. Apply gentle pressure at the injection site for 60 s and longer if the injection site continues to bleed (Fig. 11.7).