Effect of anesthesia for hypospadias repair on perioperative complications

Abstract

Hypospadias is a common anomaly among males 1 with several variations, each with a slightly different surgical approach toward correction of the defects in the urethral fold and ventral foreskin. 1 Previous studies have demonstrated that duration of surgery and type of hypospadias repair impact surgical results. Additional complicating factors were the specific surgical technique, patient age, penile engorgement, postoperative inflammatory response, and tissue edema. [1][2][3][4][5][6][7][8] Recent publications from centers in the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. [2][3][4][5] This was unexpected to many of us, AbstractBackground: Recent publications from the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. Aims:The purpose of this retrospective cohort study was to assess the impact between caudal regional anesthesia, other regional anesthesia, and no regional anesthesia on complications after hypospadias repair at a tertiary care children's hospital in Ottawa, Canada, with an expectation to changing practices if a link was found. Method:We reviewed the health records of 827 children with hypospadias undergoing penile surgery from January 1991-June 2017. The final sample size for the analysis consisted of 764 patients and 825 procedures. Results:The overall complications were almost identical when considering anesthesia effects, and this similarity persisted when we assessed specifically for only surgical complications. We had 716, 94, and 15 subjects who had a caudal block, penile block, and general anesthesia only, respectively, and their complication rates were 28, 31, and 27%, respectively, and their fistula formation rates were 10, 6, and 0%, respectively, and their stricture formation rates were 8, 7, and 20%,, respectively.Hypospadias type and surgical repair technique were marked predictors of complications in the postoperative period.Conclusion: Anesthesia technique appears to have minor impact on complications after hypospadias repair, while surgical technique and type of hypospadias impact complications after hypospadias surgery in children. Based upon these results, we will not change our current practice of using a variety of regional anesthesia techniques for children undergoing hypospadias repair. K E Y W O R D Sanesthesia, caudal, complications, hypospadias repair, regional anesthesia | 761as a caudal has been routine practice of pediatric anesthesiologists for 40+ years and is strongly supported by most surgical colleagues and families.We wanted to review our results and determine if the issues and concerns noted in other centers were also occurring at Children's Hospital of Eastern Ontario, Ottawa, Canada. If so, we would need to change our routine practice to an improved, evidence-based medicine practice, ie, stop ...

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair

“…Most of these techniques are constantly being revised and modified in order to achieve ideal results, as the rate of postoperative complications remains high. To reduce the incidence of urethrocutaneous fistula, scholars worldwide have been developing and improving surgical technologies and styles, such as individual procedures during perioperative treatment (11)(12)(13). It is reported that the preoperative application of HCG and dihydrotestosterone ointment can improve the appearance of the penis and reduce the incidence of complications (14,15).…”

Comparison of Caudal Block vs. Penile Block vs. Intravenous Fentanyl Only in Children Undergoing Penile Surgery: A Prospective, Randomized, Double Blind Study

“…We also found that motor block associated with the caudal blocks did not impact on recovery parameters. The likelihood that caudal block is associated with surgical complications in hypospadias surgery, as suggested by Saavedra-Belaunde (9), has been refuted by different studies (10) and meta-analysis (11). Rarely, when DPNB is used, the analgesics may infiltrate the tissues of the dorsal aspect of the penis and distort anatomical planes, which may cause technical difficulties and theoretically affect the procedure's success and final penile appearance.…”

Ultrasound‐guided dorsal penile nerve block vs neurostimulator‐guided pudendal nerve block in children undergoing hypospadias surgery: A prospective, randomized, double‐blinded trial

“…However, there are some concerns about its potential complications. Although a recent study showed that there was no association between caudal blocks and postoperative complications after hypospadias surgery, there are still reports about the association of caudal blocks with urinary retention, bleeding, penile engorgement, and, most commonly, fistula formation . These potential complications of caudal anesthesia have led to a search for alternative techniques with safer profiles, such as pudendal and penile blocks.…”

“…Blocks were performed before the start of surgery once the airway had been secured. A MyLab 6 US machine (Esaote) equipped with a large bandwidth, a multi-frequency linear probe (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and a 22G, 50-mm, ultrasound-visible stimulating needle (B. Braun Stimuplex Ultra 360) were used for block applications.…”