Extended Summary
Introduction
The use of caudal anesthesia at the time of hypospadias repair remains controversial
as some prior studies have reported increased postoperative complication rates associated
with caudal nerve block. However, these results have been called into question due
to confounding factors and heterogeneous study groups.
Objective
Given the importance of identifying true risk factors associated with increased hypospadias
complication rate, we examined our experience with caudal anesthesia limiting our
analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated
with increased postoperative complications.
Study Design
We retrospectively reviewed our institutional hypospadias database from June 2007
to January 2021. All boys who underwent single-stage distal hypospadias repair with
either caudal or penile block with minimum 1 month follow up were included. Records
were reviewed to determine the type of local anesthesia, type of hypospadias repair,
all complications, and time to complication. Association between any complication
and local anesthesia type was evaluated by univariate and multivariate logistic regression
analysis controlling for age at surgery and type of repair. A sub-analysis was performed
for complications occurring < 30 days.
Results
Overall, 1,008 boys, 832 (82.5%) who received caudal and 176 (17.5%) penile block,
were included. Median age at surgery was 8.1 months and median follow up was 13 months.
Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation.
Median time to complication was 10.59 months and was significantly shorter in the
caudal group (8.45 vs. 25.2 months). Caudal anesthesia was associated with higher
likelihood of complication on univariate analysis; however, this was not true on multivariate
analysis when controlling for age and type of repair. Caudal anesthesia was not associated
with increased likelihood of complication within 30 days.
Discussion
Since the association between caudal anesthesia and hypospadias complications was
first suggested, several studies have tried to answer this question with variable
results. Our findings add to the evidence that there is no association between caudal
anesthesia and increased hypospadias complications in either the short or long term.
The major strengths of our study are a large, homogenous study population, robust
follow up and inclusion of data from 14 surgeons over 14 years. Limitations include
the study’s retrospective nature as well as lack of standardized follow up protocol
throughout the study period.
Conclusions
After controlling for possible confounders, caudal nerve block was not associated
with increased risk of postoperative complications following distal hypospadias repair.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypospadias: Are we as good as we think when we correct proximal hypospadias?.J Pediatr Urol. Aug 2016; 12: 196.e1-196.e5https://doi.org/10.1016/j.jpurol.2016.05.002
- Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate.J Urol. 03. 2017; 197: 852-858https://doi.org/10.1016/j.juro.2016.11.054
- Time to Complication Detection after Primary Pediatric Hypospadias Repair: A Large, Single Center, Retrospective Cohort Analysis.J Urol. Aug. 2020; 204: 338-344https://doi.org/10.1097/JU.0000000000000762
- Meta-analysis of complication rates of the tubularized incised plate (TIP) repair.J Pediatr Urol. Apr. 2015; 11: 54-59https://doi.org/10.1016/j.jpurol.2014.12.006
- Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps.J Urol. Aug. 2015; 194: 512-516https://doi.org/10.1016/j.juro.2015.02.044
- Discrepant Rates of Hypospadias Surgical Complications: A Comparison of U.S. News & World Report and Pediatric Health Information System® Data and Published Literature.J Urol. 03. 2020; 203: 616-623https://doi.org/10.1097/JU.0000000000000554
- Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block.Paediatr Anaesth. Jul 2012; 22: 707-712https://doi.org/10.1111/j.1460-9592.2011.03702.x
- Caudal epidural blocks in paediatric patients: a review and practical considerations.Br J Anaesth. Apr. 2019; 122: 509-517https://doi.org/10.1016/j.bja.2018.11.030
- Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database.Anesth Analg. Jan. 2015; 120: 151-156https://doi.org/10.1213/ANE.0000000000000446
- Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery?.J Pediatr Urol. Feb. 2017; 13: 45.e1-45.e4https://doi.org/10.1016/j.jpurol.2016.09.011
- Impact of caudal block on postoperative complications in children undergoing tubularised incised plate urethroplasty for hypospadias repair: a retrospective cohort study.Anaesthesia. 07. 2016; 71: 773-778https://doi.org/10.1111/anae.13463
- The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.Paediatr Anaesth. Jul. 2017; 27: 688-694https://doi.org/10.1111/pan.13119
- The effect of caudal epidural block on the surgical complications of hypospadias repair in children aged 6 to 35 months: A randomized controlled trial.J Pediatr Urol. Nov. 2021; 19https://doi.org/10.1016/j.jpurol.2021.11.009
- Effect of Caudal vs. Penile Block on the Incidence of Hypospadias Complications Following Primary Repairs: A Retrospective Cohort Study.J Urol. May. 2021; 205: 1454-1459https://doi.org/10.1097/JU.0000000000001448
- Cause and Effect versus Confounding-Is There a True Association between Caudal Blocks and Tubularized Incised Plate Repair Complications?.J Urol. 03. 2017; 197: 845-851https://doi.org/10.1016/j.juro.2016.08.110
- Urethrocutaneous fistula following hypospadias repair: regional anesthesia and other factors.Paediatr Anaesth. Nov. 2015; 25: 1144-1150https://doi.org/10.1111/pan.12719
- Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis.Can Urol Assoc J. Dec 03 2018; : E249-E257https://doi.org/10.5489/cuaj.5688
Article info
Publication history
Accepted:
March 13,
2023
Received in revised form:
September 27,
2022
Received:
April 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
