To examine current opioid prescribing and determine what clinical factors were associated with use of opioids after urologic surgery after a previous study from our institution found that education regarding opioid prescribing practices significantly decreased post-operative opioid prescriptions from 61% to 34% (P <.0001).

From 2017 to 2023, a questionnaire querying what medications were used for post-operative pain was administered to patients/families at a postoperative visit. Survey results and demographic factors were obtained via retrospective chart review. Fisher’s exact and t tests compared patients who did and did not use opioids.

1630 patients’ families completed a survey, with mean age 5.3 years, 95% male. Over the study period, 550 patients (34%) were prescribed opioids, and 474/1630 (29%) used opioids post-operatively. Patients who used opioids were significantly older (7 vs 4 years, P <.0001). Endoscopic surgery (P = .0005), buried penis/torsion/chordee repair (P <.0001), meatoplasty/skin bridge (P <.0001), and alternating acetaminophen and ibuprofen (P <.0001) were associated with decreased opioid use. Families of patients who used opioids had higher rates of calling the clinic (6% vs 2%, P = .0011) and visiting the Emergency Department (ED) with pain concerns (3% vs 0.7%, P = .002). In 2017, 63% of patients were prescribed opioids after surgery compared with 6% in 2023 (P <.0001).

Most pediatric urologic surgeries can be performed without outpatient post-operative opioids. After education, we decreased opioid prescribing to only 5% of patients. The patients who were prescribed opioids had higher rates of ED visits or calling the clinic nurses with pain concerns.