Infertility & Sexual Dysfunction(구연) (E-192) 35 years experience of penile prosthesis implantations. From the beginning up to the development of local anesthetic model for a out patient day surgery. Urology, Chois's ssclinic, Urology, Chois's ssclinic Hyung KI Choi, Hyun Min Choi Background: 3piece inflatalble penile prosthesis are usually implanted under general or spinal anesthesia. Few papers are available regarding the 3piece penile prosthesis implantations under local anesthesia longterm experience and skills are needed to master penile implantation surgery under local anesthesia. / Objectives: To provide longterm developing experiences to reach to the final ideal model : implanting 3-piece penile prosthesis under local lidocaine anesthesia only as a out patient day surgery. / Materials and Methods: All the penile implantations from the dec 1983 up to the dec 2019 [n=1268] were included in this study and divided into 4 sub-groups progressively. 1) Initial learning period [1983 Dec - 1990] n=39 Started first implantation in paraplegia with Jonas. Prosthesis in Dec 1983 and set up: Sexual dysfunction clinic in Severance hospital.  Thereafter, progressively increased cases with malleable prosthesis: AMS malleable, self inflating Hydroflex and Dynaflex 2) Pre viagra period [1991-1999] n=429] With the experiences of malleable implantations, then started implanting 3-piece inflatable prosthesis under general or spinal anesthesia. In patients with dual problems of BPH and ED, penile implantation and TURP were done simultaneously in one session and name it as “Combi_surgery” 3) Post viagra and revision period [2000 – 2010] n=350] With the implantations more than 10years, there progressively appeared mechanical failures, so revisions were needed. The mechanical reliability of inflatable prosthesis were 98.2% at 2years, 95.7% at 3years, 92.2% at 6years [ Choi et al J Urology 2001 ] Among 58 case of revisions cylinder problems were most common 35, reservoir 15. Pump and connecting tube leaking 8 4) Private clinic and local anesthetic period [ 2010–2019 ] n=[450] Patients with dual problems of ED and incontinence after radical prostatectomy, we implanted 3 piece inflatable penile prosthesis, and found that 72% of incontinence were improved depending upon the percent of penile inflations, so recommended as a first line treatment option for these dual problems.[ choi et al wjmh 2016] As the practice of private clinic, the needs for a day surgery were increasing due to the patient privacy and also increasing the high risk older patients. From nov-2013, we applied local anesthetic technique for all cases of fresh, revision and even post infection cases. Local anesthetic techniques were; caudal, ilioinguinal, bilateral pudendal and penile blocks with 1% lidocaine and analgesics only.   / Results and Conclusion: 300 implantations [ 247 fresh, 53 revision ] were done under local lidocaine anesthesia only. All patients tolerated well during one hour surgery, no patient transferred to general or spinal. All patients were discharged on that day after 5 hours recovery as a out patient basis Side effect and complications inguinal hernia 2 pump failure 2 urethral erosion 1 Anxietic-phobic reactions 2 Based on longterm experiences of penile implantations, we finally developed local anesthetic model for 3 piece inflatable penile implantations as a  routine out patient day surgery. keywords : penile prosthesis implantation .under local anesthesisa .