Presentation Authors: Michel Apoj*, Mark Biebel, Archana Rajender, Didi Theva, Dayron Rodriguez, Boston, MA, Martin Gross, Dartmouth, NH, Ricardo Munarriz, Boston, MA
Introduction: 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 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 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 were in the top HgbA1C quartile. Significant postoperative pain was more common in these patients (41% versus 13%, p = 0.047) and resulted in more unplanned 30-day post-operative visits (27% versus 11%, p = 0.042). These patients 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 in the top HgbA1C quartile, which resulted in more unplanned 30-day post-operative 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.