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Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair
Jason P. Van Batavia, MD, Mark R. Zaontz, MD, Nicolas Seranio, BA, Arun Srinivasan, MD, Aseem Shukla, MD, Dana Weiss, MD, Thomas F. Kolon, MD, Douglas A. Canning, MD, Christopher J. Long, MD.
The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

BACKGROUND: Caudal anesthesia for hypospadias surgery has become a recent controversial topic. Initial studies noted increased post-operative complication rates after caudal compared to penile nerve block for hypospadias repair, although other authors questioned these findings due to confounding and heterogeneous study groups. Given the importance of identifying true factors associated with post-operative hypospadias complication rate, we examined our experience with caudal anesthesia and limited our analysis to only distal hypospadias repairs to obtain a more homogenous population. We hypothesized that caudal anesthesia would not be associated with post-operative complication rates following distal hypospadias repair.
METHODS: We retrospectively reviewed our IRB approved hypospadias database from 2007 to 2015. All boys who underwent single stage distal hypospadias repair and had at least 2 months of follow up were included. Anesthesia and operative reports were reviewed to determine if patient received caudal or penile block anesthesia. Complications, if any, were recorded for each patient including post-operative bleeding/hematoma, wound infection, urethrocutaneous fistula, persistent penile curvature, urethral stricture, urethral diverticulum, meatal stricture, and glans dehiscence. Association between any complication and anesthesia type was evaluated by univariate and multivariate logistic multivariate regression analysis controlling for age at time of surgery, severity of penile curvature, and type of surgical repair. STATA 14.2 was used for all analyses and significance was set at p<0.05.
RESULTS: In total, 449 boys with a median age of 7.5 months at time of surgery (IQR=6.4-9.8 months) fit inclusion criteria. Median follow up time was 27 months (IQR=7-42 months). Overall complication rate in this select cohort was 14.0%. Eighty-three boys (18%) underwent penile nerve blocks and 366 boys (82%) underwent caudal anesthesia at time of repair. Caudal anesthesia was associated with higher complication rate compared to penile nerve block on univariate analysis (OR=2.9, 95%CI=1.1-7.6; p=0.03). This association between anesthesia type and complication risk did not hold up on multivariate analysis when controlling for age and type of repair (OR=1.60, 95%CI=0.69-3.70; p=0.28).
CONCLUSIONS: After controlling for possible confounders, type of anesthesia (caudal vs. penile nerve block) was not associated with post-operative complication rate following distal hypospadias repair. This is the largest study to date to assess complication risk based on anesthesia type during distal hypospadias repair. The major strengths of this study are its homogenous study population and robust follow up which provide methodologic advantages over previously published reports.

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