Skip to Main Content


A wide range of urologic procedures are performed using local or regional anesthesia. This includes an orchiectomy, inspection of the painful testis, release of a paraphimosis, dorsal slit, circumcision, and even a hydrocelectomy or varicocelectomy done in the Operating Room. Emergency Physicians can utilize some of the same anesthetic techniques, namely the penile or spermatic cord blocks, to safely and painlessly perform many procedures in the Emergency Department. These techniques are easy to learn, simple to perform, and have a low risk of serious complications.


Innervation of the penis arises from the pudendal nerve that is derived from sacral levels 2 to 4. The pudendal nerve divides into the perineal and the inferior rectal nerves. The perineal nerve further divides into the right and left dorsal nerves of the penis. The dorsal nerves of the penis pass under the pubic symphysis to penetrate the suspensory ligament of the penis.1 They travel under Buck’s fascia to supply sensory innervation to the entire penis (Figure 125-1).

Figure 125-1
Graphic Jump Location

Transverse section through the base of the penis.


The primary nerve supply of the testis and epididymis are from the ilioinguinal and genitofemoral nerves. The ilioinguinal nerve is derived from the first lumbar spinal nerve. It arises slightly inferior and medial to the anterior superior iliac spine and courses toward the pubic tubercle, between the internal and external oblique muscles.1,2 It enters the inguinal canal on the anterior surface of the spermatic cord. The ilioinguinal nerve provides sensory innervation to the skin of the upper thigh, base of the penis, and the upper scrotum.3 It also provides sensory innervation to the spermatic cord and testicle. The genitofemoral nerve is derived from the first two lumbar spinal nerves. It divides into the genital branch and the femoral branch. The genital branch enters the inguinal canal at the external inguinal ring and travels with the spermatic cord. It provides sensory innervation to the lower scrotum, cremaster muscle, spermatic cord, and scrotum. The femoral branch supplies the skin of the anteromedial thigh.3


Emergency Department procedures that are facilitated by local anesthesia of the penis include dorsal slit of the foreskin, release of a phimosis or paraphimosis, repair of penile lacerations, and the release of penile skin entrapped in zippers. Local anesthesia can also be used before performing a circumcision. However, this procedure is usually performed by a Urologist.


Emergency Department indications for a spermatic cord block include the relief of epididymal pain, the facilitation of a manual or ultrasound examination when differentiating between torsion and epididymitis, and to inspect the testis following trauma. Manual detorsion of a testis may be enabled by local anesthesia when a patient cannot tolerate the pain of palpation. However, the risk of compromising the blood supply to the testis and the loss of ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.