We do not inject under the pubic bone as we believe this is truly blind procedure and difficult to compress vessels should excessive bleeding occur and the likelihood of hematoma formation is greater. In addition, do not go too proximal on the penis to avoid injection into the prepubic fat pad. Using the larger needle, draw up the anesthetic agent into the syringe and then switch to the smaller caliber needle. One can place two fingers at the base of the penis and press against the pubic bone. This allows any prepubic fat or redundant skin to move away from the base of the penis and aids in exposing the basal penile shaft. This results in more accurate targeting of the space just above Buck’s fascia.

Prepare the skin with an alcohol/chlorhexidine swab. Using a 27-gauge needle, insert the needle transversely at the 9 o’clock position and advance across the shaft of the penis while remaining above Buck’s fascia until you reach the opposite side (Figs. 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, and 4.9). Try to avoid damaging any visible vessels (Fig. 4.2). Aspirate to make sure you are not within a blood vessel. If blood is easily drawn into syringe, readjust needle location; otherwise continue. Begin injecting anesthetic agent as the needle is slowly withdrawn. Hold pressure on the treated area after the needle is removed and also help distribute any medication bulges (Fig. 4.11).