Urology

Data Analyses

• Included Procedures: Circumcision
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine March 2021 – August 2022
• 68 Opioid Naïve Patients
• Pain Score (median): 2
• Satisfaction with Pain Management (median): 5

Supporting Literature

Koo et al. 2020 (Level 4 evidence)

• doi: 10.1097/JU.0000000000000514
• 15-member multidisciplinary expert panel used a 3-step modified Delphi method to develop recommendations for postoperative opioid prescribing. Recommendations were for opioid naive patients without chronic pain conditions and included 16 endourological and minimally invasive urological procedures.
• Recommended prescription = 0-15 tablets
• Supports contextualizing postoperative pain management with patient goals and preferences and maximizing nonopioid therapies.

Grau et al. 2019 (Level 2 evidence)

• doi: 10.1097/JU.0000000000000020
• Assessed the impact of a 2-phase Plan-Do-Study-Act cycle to decrease opioid prescriptions following pediatric urological surgery.
• Analyzed data pertaining to opioid dosing and pain scores. Included 25 children at a single institution from 2016-2017.
• No significant differences were found between pain scores in the 5-dose group (31 patients) and the 10-dose group (24 patients).
• Previous recommendation = 10 doses over 5 days
• New recommended prescription = 0-2 doses

Corona et al. 2019 (Level 3 evidence)

• doi: https://doi.org/10.1016/j.jpurol.2021.01.008
• Evaluated post-operative opioid prescribing patterns after common ambulatory pediatric urology procedures (circumcision, orchiopexy, and hernia/hydrocele) at two major institutions (Michigan Medicine & University of Wisconsin) between 2016-2017.
• Included 811 circumcisions and 883 inguinal surgeries.
• Opioid prescribing is excessive and variable after pediatric ambulatory urologic surgery.
• 95.4% of patients received an opioid prescription, 75% of whom received a prescription for 15 doses or more
• Median number of doses prescribed for circumcision = 20
• Younger age, pill form, and earlier year were all associated with a greater number of opioid doses prescribed.

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529
• Analyzed data from 404 children undergoing umbilical or epigastric herniorrhaphy; laparoscopic appendectomy; inguinal herniorrhaphy and/or hydrocelectomy; adenoidectomy; circumcision; percutaneous pinning for elbow fracture or scrotal-incision orchiopexy at a single institution between April 2018- November 2018
• Caregivers were contacted 7 and 21 days after procedure regarding pain control and analgesic use.
• Included 65 circumcisions
• A discharge opioid was prescribed to 22% of patients with median 10 doses (range of 6-15 pills)
• Nearly 80% of patients undergoing a circumcision were not prescribed or did not use an opioid
• Only 1 in 3 patients used an opioid, typically for 3 days or less

Data Analysis

• Included Procedures: Hydrocelectomy, Orchidopexy, Laparoscopic Assisted Orchidopexy
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
• March 2021 – August 2022
• 84 Opioid Naïve Patients
• Pain Score (median): 2
• Satisfaction with Pain Management (median): 5

Data Analysis

• Included Procedures: Hypospadias Repair
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
  March 2021 – August 2022
• 28 Opioid Naïve Patients
  
• Pain Score (median): 3
• Satisfaction with Pain Management (median): 5

Data Analysis

• Included Procedures: Chordee Release, Meatoplasty Or Meatotomy, Penile Webbing Release/ Lysis Of Adhesions
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
  March 2021 – August 2022
• 29 Opioid Naïve Patients
• Pain Score (median): 2
• Satisfaction with Pain Management (median): 5

Supporting Literature

Bilgutay et al., 2019 (Level 3 evidence)

• DOI: 10.1016/j.purol.2019.10.021
• 200 pediatric patients, aged 6 months to 18 years, undergoing outpatient urologic surgeries, such as circumcision, orchiopexy, division of penile bands, inguinal hernia repair, meatoplasty, phalloplasty, hypospadias repair, inguinal orchiectomy, scrotal hydrocele, and excision of penile lesion
• Median number of opioid doses prescribed = 10
• Mean number of opioid doses used = 1.28
• Median number of excess doses prescribed per patient = 10
• No difference in amount of opioid used based on procedure
• Conclusion: Majority of pediatric patients used 0-2 doses of prescription pain medication after discharge, representing a small percentage of the total prescribed amount

Data Analysis

• Included Procedures: Extravesical Ureteral Reimplant – Unilateral or Bilateral, Intravesical Ureteral Reimplant – Unilateral or Bilateral
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
  March 2021 – August 2022
• 25 Opioid Naïve Patients
  
• Pain Score (median): 2
• Satisfaction with Pain Management (median): 5