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Updated: Nov 1, 2025
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Published on: January 7, 2019
Children undergoing outpatient complex penile surgery and hypospadias repair may not require opioid analgesics
Laura B Cornwell1, Paul C Campbell2, Emily Ewing3
1Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
Insights
Children undergoing penile surgery without post-operative opioids had more pain-related encounters. Minimizing opioid use in pediatric penile surgery requires careful pain management strategies.
Area of Science:
- Pediatric Urology
- Pain Management
- Surgical Outcomes
Background:
- Effective pain control is crucial after penile surgery.
- Minimizing opioid use in pediatric patients is a key objective.
Purpose of the Study:
- To compare outcomes of complex penile surgeries performed with or without post-operative opioids.
- To identify predictors of post-operative pain in children.
Main Methods:
- Retrospective review of 200 pediatric patients undergoing penile degloving or hypospadias repair (2009-2019).
- Patients were matched 1:1 based on age and surgery type, comparing those prescribed opioids versus those not.
- Primary outcomes included pain-related encounters, delayed opioid prescriptions, and pain predictors.
Main Results:
- Children not prescribed opioids had a higher rate of post-operative encounters (59% vs. 41%) and pain complaints (20% vs. 9%).
- Catheter presence (OR 2.9) and lack of opioid prescription (OR 2.6) independently predicted pain complaints.
- Delayed opioid prescriptions were similar between groups (2 patients each).
Conclusions:
- Discharge without post-operative opioids increases the likelihood of patient contact and reported pain.
- A number needed to treat of 9 suggests that for every 9 children not given opioids, one additional child will report pain.
Background/Purpose:
Pain control is important after penile surgery, and opioid use should be minimized as able. We sought to describe our experience performing complex penile surgeries with vs without post-operative opioids.
Methods:
A retrospective review of penile surgeries, including 3998 between 2009 and 2019. We identified patients <8 years who underwent outpatient penile surgery requiring either penile degloving or hypospadias repair. Patients who were or were not prescribed opioids were matched 1:1 by age and type of penile surgery. Primary outcomes of interest were pain-related encounters, delayed opioid prescription, and predictors of pain.
Results:
200 children were identified, 100 per group, with mean age 1.3 ± 0.8 years. 48% were penile degloving procedures, 31% hypospadias repairs with catheters, and the remaining 21% hypospadias repairs without catheters. Perioperative features were comparable between groups(p > 0.05). 59% of patients without opioids had an impromptu post-operative encounter vs 41%, and 20% had an associated pain complaint vs 9%(p = 0.026). Two patients in both groups received delayed opioid prescription(p = 1.00). The presence of a catheter (OR 2.9) and no opioid prescription (OR 2.6) were independent predictors for pain complaint.
Conclusions:
Patients discharged without an opioid were more likely to contact a provider postoperatively and were more likely to endorse pain complaint (number needed to treat: 9).
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