Does Caudal Analgesia Increase the Rates of Urethrocutaneous Fistula Formation After Hypospadias Repair? Systematic Review and Meta-analysis

Overview

Journal Indian J Urol

Specialty Urology

Date 2019 Aug 2

PMID 31367075

Citations 7

Authors

Prabudh Goel

Shikha Jain

Minu Bajpai

Puneet Khanna

Vishesh Jain

Devendra Kumar Yadav

Affiliations

Soon will be listed here.

Abstract

Introduction: Caudal block analgesia is administered to lower the requirements of systemic and inhaled anesthetic drugs during hypospadias surgery. However, recent reports, all clustered in a short time-span have generated controversial and mutually opposing results while evaluating caudal block as an independent risk factor for urethroplasty-related complications after hypospadias repair. There is no consensus statement on the role of caudal block analgesia in formation of urethrocutaneous fistula (UCF) after hypospadias surgery. We performed a systematic review and meta-analysis of the studies evaluating the relative rates of UCF formation after hypospadias surgery in patients who were administered caudal block analgesia versus in those who were not.

Methods: Electronic searches were performed using PubMed, PubMed Central, Google Scholar, Ovid, and the Cochrane library. Statistical analysis was performed using a fixed-effect model, odds ratios, risk ratios (RR), and heterogeneity (I) were calculated. Funnel plot was used to assess for publication bias.

Results: Seven studies with 1706 patients were included. Caudal block analgesia is associated with a significantly higher risk of UCF formation (RR: 1.81; 95% confidence interval [CI]: 1.30-2.53), ( = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48-2.74), ( < 0.00001) after hypospadias surgery. Funnel plots indicate some publication bias.

Conclusions: In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.

Citing Articles

"Surgical outcomes following caudal versus pudendal analgesia in hypospadias repair: a prospective randomized blinded pilot study".

Heera T, Bagri V, Babu R, Prasad D, Akilandeswari M, Parameswari A World J Urol. 2025; 43(1):147.

PMID: 40035847 DOI: 10.1007/s00345-025-05531-6.

Incidence of urethrocutaneous fistula after distal and midshaft hypospadias repair does not differ among patients treated with or without a protective second-layer: single tertiary centre experience.

Zulli A, Mantovani A, Gigola F, Landi L, Taverna M, Cini C Pediatr Surg Int. 2024; 41(1):29.

PMID: 39680159 DOI: 10.1007/s00383-024-05926-3.

A meta-analysis: single or double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula?.

Yuan Y, Wang Y, Liang Y, Wang Y, Ho J, Peng T Front Pediatr. 2023; 11:1091242.

PMID: 37360362 PMC: 10286861. DOI: 10.3389/fped.2023.1091242.

Effects of Caudal and Penile Blocks on the Complication Rates of Hypospadias Repair.

Karagozlu Akgul A, Canmemis A, Eyvazov A, Hurel H, Kiyan G, Umuroglu T Balkan Med J. 2022; 39(4):239-245.

PMID: 35669925 PMC: 9326942. DOI: 10.4274/balkanmedj.galenos.2022.2022-1-62.

A Perspective upon Systematic Review and Meta-analysis.

Goel P J Indian Assoc Pediatr Surg. 2021; 26(3):139-143.

PMID: 34321783 PMC: 8286020. DOI: 10.4103/0971-9261.316103.

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