Postoperative Penile Prosthesis Pain: Is it Worse in Diabetic Patients?
Michel Apoj, BS1; Mark Biebel, MD1; Archana Rajender, MD1; Dayron Rodriguez, MD; MPH1; Didi Theva, MD1; Martin Gross, MD2; Ricardo Munarriz, MD1
1Boston University School of Medicine, Boston, MA; 2Dartmouth-Hitchcock Medical Center, New Hampshire, NH
BACKGROUND: Inflatable penile prosthesis (IPP) surgery is an effective, safe and satisfactory treatment option for medication-refractory erectile dysfunction. Postoperative complications include infection, mechanical failure, erosion, and pain. Current literature suggests the need for a better approach to postoperative pain management after IPP surgery. Furthermore, targeted pain management strategies for diabetic patients have been suggested in the non-urologic literature, as several clinical studies have demonstrated that postoperative pain is different in diabetic and non-diabetic patients. The purpose of this study is to determine if there is a difference in postoperative pain after IPP placement in diabetics.
METHODS: This is a single-institution retrospective review of 173 primary penoscrotal three-piece IPP prosthesis cases performed between 2014 and 2017. The main outcome measure was the number of 30-day postoperative emergency room and unplanned clinic visits specifically for significant pain. T-test was used for mean assessment and chi-square analysis was used for proportion assessment. P values <0.05 were considered statistically significant. The top HgbA1C quartile (with values greater than or equal to 8) was compared to the other HgbA1C quartiles, for a total of 30 (23%) and 98 (77%) patients, respectively.
RESULTS: Diabetes was present in 92 (54.4%) patients and 96% of these had HgbA1C greater than 8. Significant postoperative pain was more common in patients with HgbA1C greater than 8 (41% versus 13%, p = 0.047) and resulted in more unplanned 30-day post-operative emergency room and/or clinic visits (27% versus 11%, p = 0.042). Patients with HgbA1C greater than 8 with significant postoperative pain were more likely to be managed with a combination of opiates and gabapentin (30% versus 14%, p = 0.05). There were no statistical differences in age in diabetics and non-diabetics (mean 59 versus 61, p= 0.193). Hispanic and African-American patients represented 87% of the poorly controlled diabetics compared to only 13% of white patients (p <0.001). Poorly controlled diabetics had more medical comorbidities (p < 0.001). There were no differences in intra- or postoperative surgical complications in either group.
CONCLUSIONS: Significant pain after IPP surgery was statistically higher in diabetics with HgbA1C greater than 8, which resulted in more unplanned 30-day post-operative emergency room and/or clinic visits. Approximately 90% of diabetics with HgbA1C greater than 8 were African-American and Hispanic patients. Patients with significant postoperative pain were managed with a combination of opioids and gabapentin. Future studies are required to optimize pain management in diabetics following IPP placement.
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