Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Concurrent Poster Session I Patient Risk Factors for Prolonged Opioid Dependence Following Primary Inflatable Penile Prosthesis Placement Managed with Multimodal Analgesia Rutul D. Patel, MBS 1 , Avery E. Braun, MD 2 , Architha Sudhakar, MD 2 , Jacob W. Lucas, MD 2 , Martin S. Gross, MD 3 , Jay Simhan, MD 2 1 New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA; 2 Einstein Healthcare Network, Philadelphia, PA, USA; 3 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction: Multimodal analgesia (MMA) following inflatable penile prosthesis (IPP) placement has previously demonstrated substantially improved pain and reduced opioid burden. Some patients managed with MMA, however, still require opioid pain management postoperatively. In this analysis, we examine patient-specific and perioperative factors predicting increased pain and prolonged use of opioids in the recovery period following primary IPP surgery in those managed with MMA only. Materials & Methods: This is a multicenter retrospective review of 165 primary three-piece IPP recipients from 12/2018 to 12/2020 managed with a standardized MMA protocol. Patients on narcotics preoperatively were excluded. Prolonged opioid dependence was defined as active opioid prescriptions in the Prescription Drug Monitoring Program (PDMP) 90 days after surgery in previously opioid-naïve patients. Preoperative, intraoperative and immediate postoperative factors were analyzed to assess correlative risk for increased pain and development of opioid dependence in theMMAcohort. Results: The prolonged opioid use group (2/165) demonstrated substantially higher Visual Analog Scale (VAS) pain scores in PACU (p=0.014) with trends towards higher total morphine equivalents (TME) in PACU (p=0.076). Higher TME was also observed on postoperative day 0 (p=0.0425). VAS scores on POD1 (p=0.123) and total TME prescribed at discharge (p=0.646) did not reach statistical significance. In assessing preoperative factors associated with developing opioid-dependence, age (p=0.194), race (p=0.414), BMI (p=0.202) and prevalence of diabetes (p=0.656) and chronic pain (p=0.291) did not demonstrate statistical significance. Intraoperative factors analyzed including operative time (p=0.719), surgical approach (p=1.00), cylinder size (p=0.938), use of rear-tip extenders (p=1.00), reservoir size (p=0.346) and use of drain (p=1.00) also did not yield significance. Conclusions: Patients who developed prolonged postoperative opioid dependence tended to experience higher PACU VAS scores and increased TME requirements throughout their hospitalization. MMAappears to reduce risk of prolonged postoperative opioid dependence in this series. We found no clear preoperative or operative trends for prolonged opioid dependence in MMA patients. P2 Quantifying Erectile Dysfunction Two- and Four- Weeks After Cavernous Nerve Injury: Rat Model Anna G. Quinlan, BA 1 , Sabrina Toft Hansen, MD 2 , Lars Lund, MD 2 , Peter Zvara, MD, PhD 2 1 University of Vermont Larner College of Medicine, Burlington, VT, USA; 2 University of Southern Denmark and Odense University Hospital, Odense, Denmark Introduction: Stimulation of the cavernous nerve (CN) and recording of intracavernous pressure in a rat has been used since 1989 to investigate the etiology and examine possible treatments of erectile dysfunction. The microsurgical techniques used vary between laboratories, making comparison of data difficult. We have recently described a modification to the existing method that simplifies the procedure and improves its reproducibility. The goal of this study was to validate the modified experimental setup and address the time course of erectile dysfunction following bilateral CN injury. Materials & Methods: Bilateral CN injuries were made by exposing the nerves and inducing a crush injury by clamping them for two minutes with the microneedle holder. Two and four weeks following the injury, a vertical 1.5 cm skin incision was made next to the base of the penis. Palpation of ischial tuberosity was used to locate the distal portion of the penile crus with minimal dissection. A needle connected to a PE50 pressure line was inserted into the crus. After CN exposure, the electrode was placed under the nerve, the nerve was elevated, and dried. Biocompatible silicone glue was applied to isolate the electrode and nerve from the surrounding tissue. CN was stimulated using 1.5 mA, 16 Hz, 6 V, and 5 ms pulse width stimulation parameters, for 50 seconds. Three reproducible responses were analyzed for maximum and mean intracavernous pressure as well as the area under the curve. The comparisonwas made between three study groups: shamoperated animals (n=5) which have their nerves exposed but not injured, animals two weeks (n=6), and animals four weeks after bilateral CN crush injury (n=6). Results: CN stimulations resulted in intracavernous pressure increase. Three reproducible responses were achieved in each animal. The average maximum and mean intracavernous pressure was 82 ± 4 and 71 ± 5 respectively in the sham group, 53 ± 4 and 41 ± 4 in the group two weeks following the nerve injury and 57 ± 3 and 39 ± 2 in the group four weeks following the bilateral CN injury ( Figure 1 ). The area under the curve was 39.4 ± 2.32, 22.7 ± 1.5 and 21.9 ± 1.2 in sham and the two nerve injury groups respectively ( Figure 2 ). Conclusions: The isolation of the nerve with the silicone glue resulted in reproducible intracavernous pressure increase with the CN stimulation. The bilateral CN crush injury resulted in diminished erectile response with statistically significant decrease in all measured parameters. The obtained data show that this simplified model is reproducible. P1 36