Optimizing recovery: An opioid-free pathway for reconstructive urology

Authors

  • Samantha Freeman Lahey Hospital and Medical Center
  • Michael Callegari University Hospitals Cleveland Medical Center
  • Rachel Mann University of Minnesota
  • Alex Vanni Lahey Hospital and Medical Center

DOI:

https://doi.org/10.5489/cuaj.9407

Keywords:

artificial urinary sphincter, urethroplasty, buried penis repair, opioids, reconstructive urology

Abstract

Introduction: Even small quantities of prescribed opioids for acute postoperative pain can lead to addiction, hinder recovery, and be unnecessary. This study evaluated whether an opioid-free postoperative pathway following reconstructive urologic surgery increased pain-related patient communication.

Methods: An opioid-free postoperative protocol was implemented at our institution in 2019. We conducted a case-cohort study of patients undergoing artificial urinary sphincter (AUS) placement, urethroplasty, or buried penis repair (BPR) between 2015 and 2023. Patients with concurrent surgeries or preoperative opioid use were excluded. Retrospective chart review captured demographics, surgical data, and pain-related communications within 60 days postoperatively. Statistical analysis included unpaired t-tests and chi-squared tests.

Results: The study included 360 patients: 181 opioid recipients and 179 opioid-free (BPR: 84; urethroplasty: 140; AUS: 132). No significant demographic differences were observed. Pain-related communication did not significantly differ between groups. In the non-opioid cohort, only 3.9% received an opioid within 60 days postoperatively. Pain-related communication occurred in 21% of opioid-treated patients and 16% of non-opioid patients. Among those who contacted providers for pain, 25.8% in the opioid group received refills, while 30.5% of opioid-naive patients were newly prescribed opioids (p=0.26). Most opioid-treated patients (74.2%) were managed with non-narcotic methods after initial contact.

Conclusions: An opioid-free postoperative regimen for reconstructive urologic procedures, such as urethroplasty, BPR, and AUS placement, is feasible, well-tolerated, and does not increase pain-related patient communication, supporting broader adoption of opioid-sparing approaches in surgical care.

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Published

2026-03-16

How to Cite

Freeman, S., Callegari, M., Mann, R., & Vanni, A. (2026). Optimizing recovery: An opioid-free pathway for reconstructive urology. Canadian Urological Association Journal, 20(7). https://doi.org/10.5489/cuaj.9407

Issue

Vol. 20 No. 7 (2026): CUAJ July

Section

Original Research

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