Implementation of opioid-reduced protocols after penile prosthesis surgery

Postoperative pain management after penile prosthesis (PP) has traditionally required opioid medication. Recently, urologic prosthetic surgeons have sought to establish opioid-free protocols (OFP) and/or opioid-reduced protocols (ORP) for PP postoperative pain management. We sought to investigate the adoption patterns of OFP/ORP among surgeons who perform PP surgery and identify barriers to implementation.

A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) and the Society of Urologic Prosthetic Surgeons (SUPS) via email. The survey was administered via Qualtrics. A t-test was used to analyze survey responses.

The survey was fully completed by 53 respondents. Approximately 51% (27/53) of respondents performed more than 30 implants annually. OFPs were used at least some of the time by 43% (23/53) of respondents, with 9.5% (5/53) exclusively using OFPs. In comparison, 83% (44/53) of respondents used an ORP at least some of the time, and 32% (17/53) exclusively used ORP. Of the non-opioid medications/techniques used, acetaminophen was the most common (96%, 51/53), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (92%, 49/53) and dorsal penile block (77%, 41/53). At the time of discharge, 75% (40/53) of respondents prescribed fewer than 10 doses of opioid medication, and 15% (8/53) did not prescribe any opioids. The majority of respondents using ORP/OFP were extremely satisfied (70%, 33/47), and none of the respondents were either somewhat or extremely dissatisfied.

Our study demonstrates that opioid-reduced/opioid-free regimens are widely adopted among the prosthetic urologic community. These protocols limit narcotic exposure to protect patients from adverse events related to opioids.