# Ultra-Restrictive Opioid Prescription Protocol After Inflatable Penile Prosthesis

## TL;DR

A strict opioid prescription protocol after penile implant surgery significantly reduced opioid use without increasing emergency visits.

## Contribution

An ultra-restrictive opioid protocol effectively reduced opioid prescriptions and abuse risk after penile prosthesis surgery.

## Key findings

- Opioid prescriptions at discharge dropped from 100% to 36% with the UROPP protocol.
- Patients on UROPP had zero median opioid pills prescribed compared to 19 pre-UROPP.
- Emergency department visits did not increase despite reduced opioid use.

## Abstract

Background

Addressing the opioid epidemic in the United States requires minimizing the overprescription of opioid pain medications, which poses a challenge for urologic surgeons, as postoperative pain is common after procedures such as inflatable penile prosthesis (IPP) placement. This research aimed to evaluate the impact of an ultra-restrictive opioid prescription protocol (UROPP) on pain management and opioid usage following IPP implant surgery.

Methodology

Patients undergoing IPP surgery were treated perioperatively using a UROPP with 500 mg acetaminophen and 15 mg intravenous ketorolac every six hours and opioids as needed for breakthrough pain. At discharge, some patients were given a three-day prescription of 5 mg oxycodone/325 mg acetaminophen, and all patients were given prescriptions for seven-day supplies of acetaminophen (500 mg) and ibuprofen (600 mg). When IPP surgery was performed as a same-day procedure due to COVID-19 precautions, all patients were given a three-day prescription of 5 mg oxycodone/325 mg acetaminophen at discharge. The patients on the UROPP were compared with a retrospective cohort of IPP patients treated before the institution of the UROPP. Outcomes assessed were opioid use, including total morphine milligram equivalents (MMEs), the number of opioid pills prescribed, and the need for refills or postoperative emergency visits.

Results

In total, 96 patients were analyzed (46 pre-UROPP, 50 post-UROPP) with no significant differences in baseline demographics. UROPP implementation significantly reduced opioid prescribing at discharge (100% vs. 36%, p < 0.001), median opioid pills (19.0 vs. 0.0, p < 0.001), and total MME. There was no increase in 30-day emergency department visits. Inpatient UROPP patients had the greatest reduction, with 96% discharged without opioids and low refill rates, while outpatient UROPP patients had higher refill rates but remained significantly lower than pre-UROPP levels.

Conclusions

The UROPP seems feasible and effective in reducing potentially unnecessary opioid prescribing and the risk of abuse following IPP placement.