Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Penoscrotal inflatable penile prosthesis recipients often fully recover from pain at two weeks following placement

International Journal of Impotence Research (2024)Cite this article

Subjects

Abstract

The symptoms and duration of pain following inflatable penile prosthesis (IPP) surgery remains poorly understood. We characterize postoperative pain following penoscrotal 3-piece inflatable penile prosthesis placement in patients managed with a standardized pain management protocol. This is a single-center prospective analysis of 96 virginal penoscrotal 3-piece IPP recipients (9/2019 to 9/2021) excluding patients with chronic pain, IPPs performed with alternative approaches or concomitantly with other surgeries and those with infections. Standardized pain questionnaire was performed by phone on post-operative day (POD) 2, 7, 14, and 30. The primary outcome was self-reported pain scores, measured by pain score 0–10 (0 = no pain, 10 = unbearable, “worst pain you have ever felt”) at various locations (incision, penile, scrotal, abdominal) over the first 30 days postoperatively. A majority of pain reported was outside the scrotal area with 67.6% of complaints in the shaft, glans, abdomen and incision. From POD2 to POD30, there was a significant decrease in severe pain from 46.2 to 11.1% (p = 0.05) with an increase in mild pain from 23.1 to 62.4% (p = 0.05). Roughly half of the participants (47.9%, n = 46) reported no pain by POD14. Penoscrotal IPP recipients often fully recover from pain at the two-week period following surgery and those with lingering discomfort predominantly complain of penile shaft and glans pain.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: A total of 121 patients underwent IPP placement from September 2019 to September 2021, of which 96 were considered primary cases and performed via PS approach.
Fig. 2
Fig. 3
Fig. 4: Breakdown of pain severity over 30 day post operative course.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Shindel AW, Lue TF. Medical and surgical therapy of erectile dysfunction. Endotext. 2022.

  2. Tong CMC, Lucas J, Shah A, Foote C, Simhan J. Novel multi-modal analgesia protocol significantly decreases opioid requirements in inflatable penile prosthesis patients. J Sex Med. 2018;15:1187–94.

    Article  PubMed  Google Scholar 

  3. Xie D, Nicholson M, Azaiza M, Gheiler V, Lopez I, Nehrenz GM, et al. Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications. Int J Impot Res. 2018;30:93–96.

    Article  PubMed  Google Scholar 

  4. Ellis JL, Higgins AM, Simhan J. Pain management strategies in penile implantation. Asian J Androl. 2020;22:34–38.

    Article  PubMed  Google Scholar 

  5. Raynor MC, Smith A, Vyas SN, Selph JP, Carson CC. Dorsal penile nerve block prior to inflatable penile prosthesis placement: a randomized, placebo-controlled trial. J Sex Med. 2012;9:2975–9.

    Article  PubMed  Google Scholar 

  6. Otero JR, Manfredi C, Wilson SK. The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation. Int J Impot Res. 2020;34:128–37.

    Article  PubMed  Google Scholar 

  7. Eid JF. No-touch technique. J Sex Med. 2011;8:5–8.

    Article  PubMed  Google Scholar 

  8. Morey AF, Cefalu CA, Hudak SJ. High placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013;10:603–10.

    Article  PubMed  Google Scholar 

  9. Lucas J, Gross M, Yafi F, Delay K, Christianson S, El-Khatib FM, et al. A multi-institutional assessment of multimodal analgesia in penile implant recipients demonstrates dramatic reduction in pain scores and narcotic usage. J Sex Med. 2020;17:518–25.

    Article  CAS  PubMed  Google Scholar 

  10. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)Scale (CPGS), Short Form-36 Bodily Pain Scale. Arthritis Care Res. 2011;63:S2410–252.

    Article  Google Scholar 

  11. Grande P, Antonini G, Cristini C, Berardinis ED, Gatto A, Lascio GD, et al. Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis. World J Urol. 2018;36:1167–74.

    Article  PubMed  Google Scholar 

  12. Palmisano F, Boeri L, Cristini C, Antonini G, Spinelli MG, Franco G, et al. Comparison of infrapubic vs penoscrotal approaches for 3-piece inflatable penile prosthesis placement: do we have a winner? Sex Med Rev. 2018;6:631–9.

    Article  PubMed  Google Scholar 

  13. Candela JV, Hellstrom WJ. Three-piece inflatable penile prosthesis implantation: a comparison of the penoscrotal and infrapubic surgical approaches. J La State Med Soc. 1996;148:296–301.

    CAS  PubMed  Google Scholar 

  14. Wallen JJ, Madiraju SK, Wang R, Henry GD. Implementation of length expanding inflatable penile prosthesis is not sufficient to prevent postsurgical penile shortening. Asian J Androl. 2018;21:98–100.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Caraceni E, Utizi L, Angelozzi G. Pseudo-capsule “coffin effect”: how to prevent penile retraction after implant of three-piece inflatable prosthesis. Arch Ital Urol Androl. 2014;86:135–7.

    Article  PubMed  Google Scholar 

  16. Wilson SK, Delk JR, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006;3:736–42.

    Article  PubMed  Google Scholar 

  17. Henry GD, Mahle P, Caso J, Eisenhart E, Carrion R, Kramer A. Surgical techniques in penoscrotal implantation of an inflatable penile prosthesis: a guide to increasing patient satisfaction and surgeon ease. Sex Med Rev. 2015;3:36–47.

    Article  PubMed  Google Scholar 

  18. Wolfe AR, Davenport MT, Rozanski AT, Shakir NA, Ward EE, West ML, et al. An update on oxidized regenerated cellulose (fibrillar™) in reducing postoperative corporal bleeding following inflatable penile prosthesis surgery. Transl Androl Urol. 2020;9:43–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. O’Rourke TK, Erbella A, Zhang Y, Wosnitzer MS. Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction. Transl Androl Urol. 2017;6:S832–48.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Campbell JD, Chan EP, Pierdominico AD, Karakus S, Trock B, Brock GB, et al. Chronic pain associated with penile prostheses may persist despite revision or explantation. Can Urol Assoc J 2022;16:42–46.

    PubMed  Google Scholar 

  21. Chung D, Patel P. Chronic pain after inflatable penile prosthesis implantation: an important complication to discuss with patients. Can Urol Assoc J. 2021;16:47.

    Article  Google Scholar 

  22. Sayyid RK, Taylor NS, Owens-Walton J, Oberle MD, Fratino KL, Terris MK, et al. Pudendal nerve block prior to inflatable penile prosthesis implantation: decreased intra-operative narcotic requirements. Int J Impot Res. 2023;35:1–5. https://doi.org/10.1038/s41443-021-00495-8.

  23. Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. Lancet. 2019;393:1547–57.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell MB. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172:425–30.

    Article  PubMed  Google Scholar 

  25. Robles J, Abraham NE, Brummett C, Davies B, Graff V, Gupta R, et al. Rationale and strategies for reducing urologic post-operative opioid prescribing. AUA White Paper. 2020;1–13.

  26. Overton HN, Hanna MN, Bruhn WE, Hutfless S, Bicket MC, Makary MA, et al. Opioids after surgery workgroup. opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg. 2018;227:411–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Narang GL, Figler BD, Coward RM. Preoperative counseling and expectation management for inflatable penile prosthesis implantation. Transl Androl Urol. 2017;6:S869–80.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No financial funding was received in support of the study.

Author information

Authors and Affiliations

  1. Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, PA, USA

    Alice Xiang, Avery E. Braun & Daniel Swerdloff

  2. Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Alice Xiang, Avery E. Braun, Chrystal Chang & Jay Simhan

  3. Department of Urology, University California of San Francisco, San Francisco, CA, USA

    Avery E. Braun

  4. Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Martin S. Gross

Authors
  1. Alice Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Avery E. Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chrystal Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Swerdloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin S. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jay Simhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AEB and AX designed the work that led to submission, contributed to data extraction and drafted the manuscript. DS helped write the manuscript; CC provided feedback on the report; JS and MSG conceived the work that led to the submission, revised the manuscript and approved the final version.

Corresponding author

Correspondence to Jay Simhan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiang, A., Braun, A.E., Chang, C. et al. Penoscrotal inflatable penile prosthesis recipients often fully recover from pain at two weeks following placement. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00871-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-024-00871-0

Search

Advanced search

Quick links