Date Published: August 15, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Gerard D. Henry, Antonino Saccà, Elizabeth Eisenhart, Mario A. Cleves, Andrew C. Kramer.
The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure’s perceived success. In analyzing surgical outcomes, assessment of the anesthetic for postoperative pain and side effects should be included. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. Fifty-seven patients were included in final analysis. Patients who had more than one procedure that day or who used chronic pain medication were excluded. The type and amount of each drug used for each respective side effect (within the first 24 hours after procedure) were compared to determine relative benefit. Twenty patients received general anesthesia (denoted herein as “GA”) and 37 received spinal (or also known as subarachnoid) anesthesia (denoted herein as “SA”). Patients receiving GA had significantly greater (P < 0.0001) occurrence and amount of intravenous pain treatment than those receiving SA. Patients with SA required less intravenous pain medication and less treatment for nausea/emesis.
Penile prosthetic surgery has undergone significant changes since its introduction in the 1970’s and it is now considered a safe and effective method of treating end organ failure impotence. As established by Pearman, an early leader in research in the field of surgical erectile dysfunction, impotence is defined as the inability to gain or maintain an erection sufficient to sustain satisfactory intercourse due to pathology or deformation of the penis . The history of modern surgical treatment for erectile dysfunction began with the development of the inflatable penile prosthesis by Scott in the 1970s . The popularity of inflatable penile prosthetics has increased since, and as the early designs yielded high failure rates, multiple revisions to the design and material have taken place. Current penile prosthetic implantation procedures prove to be both reliable and durable, with approximately 18,000 devices implanted annually worldwide . With increased social awareness regarding erectile dysfunction, it appears there will be significant increases in penile prosthetic implantations in the future.
A retrospective study was conducted by reviewing medical records for 90 consecutive penile prosthetic implantation procedures which were performed by one surgeon at a private institution. There was no standard anesthetic in existence at this center. All patients provided written, informed consent as approved by the local hospital institutional review board.
Fifty-seven patients who underwent penile prosthetic implantations were included in the study: 20 surgeries were performed under GA and 37 were performed under SA. There was no significant difference in age (63.1 GA versus 60.8 SA), race, or etiology of impotence (23% diabetic GA versus 31% diabetic SA) between the GA and SA groups.
The major complaint of patients undergoing penile prosthesis surgery in the perioperative period is surgical pain . A review of the literature revealed no prior published papers addressing this complaint among patients undergoing an elective procedure where patient satisfaction remains of paramount importance. The overall purpose of this study was to explore the administration of GA and SA in primary penile prosthetic implantation procedures and determine whether there is any benefit of one anesthetic over the other. Previous studies have compared GA versus SA in terms of intraoperative and postoperative outcomes [15–24], with varying conclusions. Our study is the first to compare outcomes in penile prosthesis surgery; comparisons to existing literature possess limitations due to differences in the procedures which are performed.
Based upon our analysis, there is no significant difference between GA and SA in terms of operative time, anesthetic time, and oral pain medications among the patients who received penile implantations. However, with spinal anesthesia, the patients presented with more urticaria. Conversely, greater amounts of intravenous pain medications and treatment of nausea/emesis medication were necessitated by general anesthesia use.