Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

Abstract

Urologic procedures (both open and minimally invasive) can cause pain due to the surgery itself, devices placed, and post-operative issues. Thus, pain management is important for every post-procedure recovery period. Opioid use post-surgery is common and often over-prescribed contributing to persistent use by patients. In this article, we review the extent of opioid use in pediatric urologic procedures, vasectomy, endourologic procedures, penile implantation, urogynecologic procedures, prostatectomy, nephrectomy, cystectomy, and scrotal/testicular cancer surgery. Generally, we have found that institutions do not have a standardized protocol with a set regimen to prescribe opioids, resulting in more opioids being prescribed than needed and patients not properly disposing of their unused prescriptions. However, many institutions recognize their opioid overuse and are implementing new multimodal opioid-sparing analgesics methods such as non-opioid peri-operative medications, minimally invasive robotic surgery, and nerve blocks or local anesthetics with varying degrees of success. By shedding light on these opioid-free methods and prescription protocols, along with improved patient education and counselling, we hope to bring awareness to institutions and decrease unnecessary opioid use.

Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis

“…This is in contrast to prior literature in which surgical type and approach were both associated with differences in opioid prescription. 8,17,24 Okoro et al found that patients undergoing open surgery for kidney cancer were more likely to receive higher doses of opioids. 18 However, we hypothesize that patients undergoing open surgery had a longer hospital recovery with inpatient opioids; these patients are more likely to have achieved pain control at discharge, resulting in a comparable opioid-free discharge rate compared to patients with minimally invasive surgery.…”

“…5,6 Lack of standardization and variation in prescribing patterns has the potential to lead to overprescribing; prior literature establishes that up to 77% of prescribed options go unused following prostate and kidney surgery. [7][8][9] Additionally, surgical specialties continue to lack formal training on pain management, perpetuating a cycle for physicians in training. 10 Opioid-free discharge has been shown to be safe and feasible for a variety of urologic procedures.…”

Assessing psychiatric risk with a focus on optimizing patient satisfaction with penile prosthesis placement—a narrative review

“…Historical pain regimens have relied heavily on opioid medications. Given the potential risk for adverse use, abuse, and dependence, it is imperative that urologic surgeons focus on non-opioid interventions to minimize the need for opioids ( 41 ). Multi-modal approaches that include administration of local anesthetic blocks intraoperatively coupled with oral anti-inflammatories and neuropathic pain agents can dramatically reduce the need for opioids after PP placement ( 42 ).…”