Introduction: Increased postoperative scrotal pain following inflatable penile prosthesis (IPP) implantation is a principal argument of many detractors of the penoscrotal approach. However, there remains a paucity of work assessing severity, location and duration of pain following IPP surgery. We thoroughly characterize postoperative pain following penoscrotal IPP in patients managed with a standardized multimodal analgesia (MMA) protocol.
Methods: This is a single-center, prospective analysis of 98 virginal penoscrotal IPP patients utilizing MMA (a standardized protocol of acetaminophen, gabapentin, and NSAIDs) from 9/2019 to 9/2021. Patients with chronic pain, those ineligible for MMA, alternative surgical approaches, concomitant surgeries or infections were excluded. Follow-up was executed on POD 2, 7, 14, and 30 with a standard questionnaire (Figure 1A). Pain scores were stratified based by visual analogue score (VAS) to none/mild (VAS=0-3), moderate (VAS=4-6) & severe (VAS=>7).
Results: Pain locations/trends are found in Figure 1B. Most “area of most bother” following IPP was external to the scrotum throughout recovery (70% vs 30% POD2; 65% vs 35%, POD7; 62% vs 38% POD14; & 70% vs 30% POD30, p= <0.001) with only the penile shaft and glans significantly increasing in bother from 20% POD2; 28% POD7; 27% POD14; to 38% POD30 (p=0.023).
Patients reporting no to mild pain increased from 23.1% to 70.4% while those reporting severe pain decreased from 46.2% to 11.1% from POD2 to 30 (p=0.05). In those with severe pain, “area of most bother” was incisional on POD2 (35.7%) and POD7 (37.5%), glanular on POD14 (50%) and on the shaft on POD30 (50%). 7/98 (7.1%) patients required narcotic refills and all experienced severe pain with higher average VAS scores compared to the rest of the cohort (7.0 vs 5.2 POD2, 7.3 vs 5.3 POD7, 7.0 vs 3.6 POD14, and 5.4 vs 2.3 POD30, p=0.019).
Conclusions: We report a thorough assessment of the pain profile experienced by penoscrotal IPP recipients in the first postoperative month. While proponents of infrapubic and subcoronal approaches anecdotally postulate decreased postoperative pain due to reduced scrotal manipulation, we objectively demonstrate that most penoscrotal IPP patients complain of penile shaft and glans penis pain.