Effect of Caudal vs. Penile Block on the Incidence of Hypospadias Complications Following Primary Repairs; A Retrospective Cohort Study.

Adler, Adam C; Chandrakantan, Arvind; Lee, Andrew D; Koh, Chester J; Janzen, Nicolette K; Austin, Paul F

PURPOSE Primary repair of hypospadias is associated with risk of complications, specifically urethra-cutaneous fistula and glanular dehiscence. Caudal block may potentially increase the risk of these complications. Therefore, we studied the incidence of hypospadias complications in children that underwent correction at our institution having received either penile or caudal block. METHODS We analyzed all primary hypospadias repair cases from December 2011 through December 2018 at Texas Children's Hospital with a minimum of 1-year follow-up for the presence of complications: urethra-cutaneous fistula and glanular dehiscence. Surgical (surgeon, operative time, block type, local anesthetic, meatal position) and patient (age at correction, prematurity) factors were additionally analyzed. RESULTS For the primary aim, 983 patients underwent primary hypospadias correction with a minimum of one year of postoperative follow-up data. There were 897 patients (91.3%) in which no complications were identified and 86 (8.7%) with either urocutaneous fistula (n=81) or glanular dehiscence (n=5). Of the 86 identified complications, (45/812 (5.5%) were distal, 41/171 (24%) were proximal; p=<0.001) with a complication, Rate of complications was not associated with caudal block (OR: 0.67, 95% CI: 0.41-1.09; p=0.11). On univariable analysis, age (OR 1.12, 95% CI 1.04-1.20; p=0.04), surgical duration (OR 1.02; 95% CI 1.01-1.02; p=<0.001), prematurity <32 weeks (OR 4.38, 95% CI 1.54-4.11 p=<0.001) and position of meatus as proximal (OR 5.38 95% CI 3.39-8.53; p=<0.001) were associated with an increased rate of complications. However, on multivariable analysis, associations of age (OR: 1.13, 95% CI: 1.05-1.22; p=0.001), surgery duration (OR: 1.01, 95% CI: 1.01-1.02; p=<0.001) and meatal position (OR: 3.85, 95% CI: 2.32-6.39; p=<0.001) were associated with increased rate of complications. CONCLUSION Our data suggests that meatal location, older age, extreme prematurity and surgical duration are associated with increased incidence of complications (urethra-cutaneous fistula and glanular dehiscence) following hypospadias correction. Analgesic block was not associated with increased hypospadias complication risk.