Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team

Wong, Yin Cheong; Pang, Kristine Kit Yi; Tam, Y. H.

doi:10.12809/hkmj177039

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…The safety, feasibility, and efficiency of the introduction of ERAS protocols in pediatric surgery has been validated. [43][44][45][46][47][48][49] These studies reported a significant decrease of the postoperative opioid intake, time to regular diet, time to intravenous fluid discontinuation, intraoperative fluid volume, LOS, and finally in the total costs when applying ERAS protocols. [43][44][45][46][47][48][49] This supports the fact that the introduction of ERAS protocols improves patient recovery after surgery without increasing the incidence of complications, the readmission rate, or the financial burden on the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…[43][44][45][46][47][48][49] These studies reported a significant decrease of the postoperative opioid intake, time to regular diet, time to intravenous fluid discontinuation, intraoperative fluid volume, LOS, and finally in the total costs when applying ERAS protocols. [43][44][45][46][47][48][49] This supports the fact that the introduction of ERAS protocols improves patient recovery after surgery without increasing the incidence of complications, the readmission rate, or the financial burden on the hospital. 50 Despite these encouraging results, there is a significant lack of data on ERAS application in pediatric neurosurgical practice.…”

Section: Discussionmentioning

confidence: 99%

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The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience

Belouaer,

Cossu,

Al-Tayyari

et al. 2023

Neurosurgical Focus

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OBJECTIVE Over the past decade, the Enhanced Recovery After Surgery (ERAS) program has demonstrated its effectiveness and efficiency in improving postoperative care and enhancing recovery across various surgical fields. Preliminary results of ERAS protocol implementation in craniosynostosis surgery are presented. METHODS An ERAS protocol was developed and implemented for cranial pediatric neurosurgery, focusing on craniosynostosis repair. The study incorporated a pre-ERAS group consisting of a consecutive series of patients who underwent craniosynostosis repair surgery prior to the implementation of the ERAS protocol; the results were compared with a consecutive group of patients who had been prospectively collected since the introduction of the ERAS for craniosynostosis protocol. The safety, feasibility, and efficiency of the ERAS protocol in pediatric neurosurgery was evaluated, through the collection of clinical data from the pre-, intra-, and postoperative phase. Surgery-related complications were evaluated according to the Clavien-Dindo classification. Costs of the stays were obtained using a microcosting approach. RESULTS A total of 35 pre-ERAS patients and 10 ERAS patients were included. Scaphocephaly was the most common pathology in both groups. The overall compliance with the pre-, intra-, and postoperative criteria significantly increased—from 35.5%, 64.4%, and 54.7%, respectively, in each phase to 94%, 90%, and 84% (p < 0.001). The authors noticed a reduction in the average opioid dose used per patient in the ERAS group (p = 0.004), and they observed a trend toward a decreased mean length of stay from 5.2 days in the pre-ERAS group to 4.6 days in the ERAS group, without an increase of the rate of readmission within 30 days of surgery. The rate of complications decreased but this difference was not statistically significant. The hospital costs lowered significantly: from 21,958 Confederatio Helvetica Francs (CHF) in the pre-ERAS group to 18,936 CHF in the ERAS group (p = 0.02). CONCLUSIONS The ERAS protocol represents a safe and cost-effective tool for the perioperative management of craniosynostosis. It showed its positive impact on the analgesia provided and on the reduction of in-hospital costs for these patients. ERAS protocols may thus be interesting options in the pediatric neurosurgical field.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience

Belouaer,

Cossu,

Al-Tayyari

et al. 2023

Neurosurgical Focus

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“…We did not encounter any major complications with both blocks. Wong et al [ 3 ] had evaluated the implementation of enhanced recovery protocol in hypospadias repair surgeries and were successful in it. Postoperative pain is a major contributing factor in enhanced recovery after surgery; hence, the routine administration of PNB in patients undergoing hypospadias repair may allow early discharge from hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Hypospadias is characterized by a proximal urethral opening, which can be located anywhere from the ventral aspect of the glans to the perineum; based on this ectopic urethral meatus, it is classified into distal penile, midshaft, or proximal hypospadias [ 4 ]. Surgery is inevitable to correct the defect; hence, it is generally recommended in early childhood for improved function and cosmesis [ 3 ]. Surgery is known to be associated with severe pain in the postoperative period, which is not adequately managed by systemic analgesia [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Observational Study Analyzing the Analgesic Efficacy of Caudal Block and Nerve Stimulator-Guided Pudendal Nerve Block in Children Undergoing Hypospadias Repair

Hayaran,

Kaushik,

Yadav

et al. 2023

Cureus

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Introduction: Hypospadias repair is a common pediatric surgery. While caudal block (CB) is the most widely used procedure for analgesia, pudendal nerve block (PNB) can be utilized as an alternative. We evaluated the postoperative analgesic efficacy of CB and PNB in children undergoing hypospadias repair. Methods: In this prospective observational study, we evaluated 101 patients who received standard general anesthesia along with CB or PNB. Postoperative pain score (Face, Legs, Activity, Cry, and Consolability {FLACC} score) along with the total number of analgesic doses and the total amount of analgesic drugs consumed within 24 hours were noted. Time to first rescue analgesia, post-block penile length and midshaft circumference, surgeon satisfaction score, and postoperative complications were also evaluated. Results: Out of 101 patients observed, 50 received CB, and 51 received PNB. At 24-hour interval, the median FLACC score in CB was 6, while in the PNB, it was 4 (p<0.001). None of the patients who were given PNB received more than three doses (p<0.001), and the average consumption of analgesic drugs within 24 hours was significantly higher in CB (38.4±4.28) compared to PNB (21.7±6.33) (p<0.0001). The median time to first rescue analgesia in CB was four hours, while in patients receiving PNB, it was eight hours (p<0.001). The increase in penile volume was significantly higher with CB as compared to PNB (p<0.001). Surgeon satisfaction score was found to be better with PNB (p<0.002). Conclusion: Patients who received PNB had significantly reduced pain scores and analgesic consumption in the first 24 hours post surgery.

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“…Urethral closure depends on the transformation of testosterone into dihydrotestosterone (DHT) (anabolic steroid of 5α-reductase type II), binding of DHT ligand with nuclear apparatus of androgen and the following respective androgen receptors activities (AR). The last two studies highlighted the influence of progesterone on the increase in the risk of hypospadias development(Carmichael et al, 2012;de Andrade et al, 2017;Wilkinson et al, 2017;Wong et al, 2018;Wu et al, 2018).…”

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confidence: 99%

The Ways of Improvement of the Methods of Hypospadias Treatment in Children: Literature Review

Zharkimbayeva¹,

Dyusembayev²,

Аубакиров³

et al. 2019

PTQ

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The relevance of the study is due to the fact that hypospadias is a congenital defect of the urogenital system in boys. The incidence rate of hypospadias differs in different countries. The main etiological factor of this defect development is a hormonal imbalance of different origin in mothers. Hypospadias can be corrected only surgically. Currently, there are a number of surgical approaches used, but still, the number of complications in the postoperative period remains high. The purpose of the article was to evaluate the outcomes of surgical correction of hypospadias in children observed after different approaches to urethroplasty involving transplanting. The authors performed a search for articles in electronic databases Pub Med, Elsevier, Scopus, Web of Science for the period from 2007 to 2018. The authors reviewed 265 articles dedicated to the correction of hypospadias by the following methods: TIP (tabularized incised plate), Mathieu, GTIP (graft tabularized incised plate) and two-stage Bracka urethroplasty. The most widespread complications mentioned in different studies were fistulas, stenosis of the urethral neo-meatus, and secondary deformation of the penis. Current approaches to surgical correction of hypospadias in children do not provide complete recovery from post-operative complications. Due to this fact, the issues of treatment of hypospadias remain relevant, requiring the development of new approaches to urethroplasty.

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Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team

Cited by 6 publications

References 22 publications

The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience

The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience

A Prospective Observational Study Analyzing the Analgesic Efficacy of Caudal Block and Nerve Stimulator-Guided Pudendal Nerve Block in Children Undergoing Hypospadias Repair

The Ways of Improvement of the Methods of Hypospadias Treatment in Children: Literature Review

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