Implementation of opioid-reduced protocols after penile prosthesis surgery.

Area of Science:

• Urology
• Pain Management
• Surgical Protocols

Background:

• Postoperative penile prosthesis (PP) pain management traditionally relied on opioids.
• There's a growing trend among urologic prosthetic surgeons to implement opioid-free protocols (OFP) or opioid-reduced protocols (ORP).
• This study investigates the adoption and barriers of OFP/ORP in PP surgery.

Purpose of the Study:

• To examine the adoption patterns of opioid-free/opioid-reduced protocols in penile prosthesis surgery.
• To identify challenges faced by surgeons when implementing these opioid-sparing pain management strategies.
• To assess surgeon satisfaction with OFP/ORP in the context of penile prosthesis placement.

Main Methods:

• A confidential 13-question survey was distributed to members of the Sexual Medicine Society of North America (SMSNA) and the Society of Urologic Prosthetic Surgeons (SUPS).
• Survey data was collected and analyzed using Qualtrics and a t-test.
• The survey focused on current practices, medication use, and satisfaction related to opioid-sparing pain management after penile prosthesis surgery.

Main Results:

• 43% of respondents use OFPs sometimes, with 9.5% exclusively using them; 83% use ORPs sometimes, with 32% exclusively using them.
• Acetaminophen (96%) and NSAIDs (92%) were the most common non-opioid adjuncts, with dorsal penile blocks used by 77%.
• Most surgeons (75%) prescribed <10 opioid doses at discharge, and 15% prescribed none; 70% reported high satisfaction with OFP/ORP.

Conclusions:

• Opioid-reduced and opioid-free regimens are widely adopted within the prosthetic urology community.
• These protocols successfully minimize opioid exposure for patients undergoing penile prosthesis surgery.
• The adoption of OFP/ORP contributes to enhanced patient safety by reducing opioid-related adverse events.