Innovative Findings Characterizing the Location and Severity of Postoperative Pain Following Inflatable Penile Prosthesis Surgery Managed With Multimodal Analgesia

Abstract

ABSTRACT Introduction Adoption of multimodal analgesia (MMA) in inflatable penile prosthesis (IPP) surgery has changed the management landscape by decreasing reliance on opioid usage for postoperative pain. However, there remains a paucity of literature characterizing severity, location and duration of postoperative pain following inflatable penile prosthesis (IPP) placement. Objective We rigorously characterized postoperative pain throughout the recovery period following IPP implantation in patients managed with multimodal analgesia (MMA). We aimed to provide an innovative and detailed analysis to better understand the pain profile experienced by implant recipients. Methods This is a single-center prospective analysis of 64 patients who underwent penoscrotal approach, primary three-piece IPP surgery from 9/2019 to 8/2020. All revision cases, infrapubic and combination anti-incontinence cases were excluded along with chronic pain patients. Interval follow-up was conducted via telephone with a standardized, validated pain questionnaire, executed on a scheduled timeline. A flow chart of the timeline and survey components are illustrated in Figure 1. Patient pain scores were assessed with the Wong-Baker visual analog scale (VAS). Results Pain locations and trends are illustrated in Image 1. Average VAS improved over the entire recovery period from 5.16 on POD2, to 5.28 on POD7, 3.55 on POD14 and 2.31 on POD30 (p=0.039). Patients were most bothered by scrotal pain followed closely by incisional pain (p=0.381) throughout the thirty days at each time interval. 20/27 (74%) patients indicated adequate pain management with MMA while 7/27 (26%) reported poorly controlled pain. No patients required additional narcotics. 27/64 (42.2%) patients had a 100% phone response rate and another 8/64 (12.5%) responded to three of the four postoperative calls. Barriers included no response to voicemail (12/64, 18.7%), full voicemail box (5/64, 7.8%) and wrong/nonfunctioning number (3/64, 4.7%). Conclusions This is the first descriptive analysis of the pain profile experienced by IPP patients during the first postoperative month. Although most patients experienced incisional and scrotal pain following penile implantation, multimodal analgesia provides reasonable pain relief for most patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast