Pain Management Strategies in Urethral Reconstruction

A Narrative Review

Chrystal Chang; Dmitriy Nikolavsky; Melody Ong; Jay Simhan

Disclosures

Transl Androl Urol. 2022;11(10):1442-1451. 

In This Article

Abstract and Introduction

Abstract

Background and Objective: Few investigations explore pain recovery comprehensively following urethral reconstruction, and understanding pain pathways that lead to discomfort following reconstruction has posed challenges. Options for pain control aside from opioids continue to be in the early forms of investigation, and remain an important strategy to combat the well-documented burden of the opioid epidemic. We conduct a detailed assessment of pain pathways in patients undergoing urethral reconstruction and further outline non-narcotic based pain management strategies in those undergoing urethroplasty.

Methods: We performed a literature review to describe pain pathways involved in urethral reconstruction with buccal graft, and postoperative pain recovery. We searched for pain management techniques performed by fields similar to urology, and those being utilized in urethroplasty with buccal graft.

Key Content and Findings: Innervation of the penoscrotal areas and mouth are well-defined, but understanding postoperative pain after urethroplasty remains a challenge. Preventative analgesia, nerve blocks, and multimodal analgesia have been employed by colorectal and gynecological surgeons. Urologists have utilized similar techniques for patients undergoing urethral reconstruction with buccal graft.

Conclusions: Few investigations explore pain recovery comprehensively following urethral reconstruction, but we believe that utilizing a combination of preventative analgesia, nerve blocks, and multimodal analgesia will have acceptable outcomes in post-surgical patients undergoing recovery. Additional work is required to further explore how combined pain management strategies can optimally reduce postoperative pain.

Introduction

Rationale and Background

Male urethral strictures can cause lower urinary tract pain and significantly diminish quality of life. Most patients reassuringly report improved pain relief following urethral reconstruction, as well as resolution from irritative lower urinary tract symptoms that affect quality of life prior to surgery.[1] Although the high success rates and tolerance of urethroplasty allows for a successful outcome following repair, possible post-surgical complications may include perineal and scrotal pain, as well as persistent oral discomfort in patients who undergo harvest of buccal mucosa grafts. Few investigations explore pain recovery comprehensively following urethral reconstruction and understanding pain pathways that lead to discomfort following reconstruction has posed challenges. Importantly, understanding such modulation pathways may provide a guide for minimization of narcotic-based pain control following surgery since opioids remain a mainstay of treatment for patients with discomfort in the postoperative setting. Further, options for pain control aside from opioids continue to be in the early forms of investigation and remain an important strategy to combat the well-documented burden of the opioid epidemic.[2]

Objectives

Here, we conduct a detailed assessment of pain pathways in patients undergoing urethral reconstruction and further outline non-narcotic based pain management strategies in those undergoing urethroplasty. We present the following article in accordance with the Narrative Review reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-363/rc).

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