SOC
Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

eISSN: 3023-7289
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Original Article
Effects of preoperative caudal epidural block on surgical outcomes in distal hypospadias surgery
Abstract
Aims: Hypospadias is an anomaly of the urogenital system with an incidence of approximately 0.5% in children. Caudal epidural block (CEB) is one of the most preferred analgesia methods in hypospadias surgery. Recently, there have been reports in the literature about an increase in postoperative complications (especially fistula) due to CEB after hypospadias surgery. In this study, we aimed to retrospectively evaluate the effect of CEB analgesia on surgical outcomes in distal hypospadias surgery performed in our center.
Methods: The study included 63 pediatric patients operated for distal hypospadias between 2020 and 2023. These patients were divided into two groups according to whether CEB was applied during surgery or not. Patients were evaluated in terms of surgical technique, age, and complications.
Results: A total of 63 pediatric surgeries with a mean age of 45.12±26.76 months and ranging from 1 to 10 years were analyzed. 63 cases with subcoronal hypospadias were included in the study. 26 cases(41.3%) underwent CEB, while 37 cases(58.7%) received intravenous analgesia (IA).The surgical complication rate in our study was 34.9%(n=22). There was no significant difference in postoperative complications between CEB and IA groups.
Conclusion: In this study, there was no statistically significant difference in the incidence of postoperative complications between CEB and IA in children operated for distal hypospadias. CEB can be used as a safe pain management method in hypospadias repair. However, we think that prospectively designed studies with a larger number of patients will be more useful in clarifying the issue.

Keywords : Anesthesia, epidural, caudal, child, hypospadias, postoperative complications

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1. Yu X, Nassar N, Mastroiacovo P, et al. Hypospadias prevalence and trends in international birth defect surveillance systems, 1980-2010. Eur Urol. 2019;76(4):482-90. doi: 10.1016/j.eururo.2019.06.027
2. Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res. 2023;35(1):61-66. doi: 10.1038/s41443-022-00563-7
3. Wood DN, Andrich DE, Greenwell TJ, Mundy AR. Standing the test of time: the long-term results of urethroplasty. World J Urol. 2006;24(3):250-254. doi: 10.1007/s00345-006-0057-3
4. Wilcox D, Snodgrass W. Long-term outcome following hypospadias repair. World J Urol. 2006;24(3):240-243. doi: 10.1007/s00345-006-0059-1
5. Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT. Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block: surgical outcome hypospadias repair. Pediatr Anesth. 2012; 22(7):707-712. doi: 10.1111/j.1460-9592.2011.03702.x
6. Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol. 2019;35(3):222. doi:10.4103/iju.IJU_252_18
7. Zhu C, Wei R, Tong Y, Liu J, Song Z, Zhang S. Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis. Reg Anesth Pain Med. 2019;44(2):259-267. doi: 10.1136/rapm-2018-000022
8. Koul A, Shukla D, Aggrawal SK, Sethi N. Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: a randomized pilot study. J Pediatr Urol. 2022;18(1):58.e1-58.e7. doi: 10.1016/j.jpurol.2021.11.006
9. Aydın A, Sönmez MG, Büyükşerbetçi M, Salar R. The use of tubularized incised plate urethroplasty to repair distal hypospadias in a peripheral state hospital. J Urol Surg. 2019;6(3):231-237. doi:10.4274/jus.galenos.2019.2388
10. Bhat A, Mandal A. Acute postoperative complications of hypospadias repair. Indian J Urol. 2008;24(2):241. doi:10.4103/0970-1591.40622
11. Saavedra-Belaunde JA, Soto-Aviles O, Jorge J, Escudero K, Vazquez-Cruz M, Perez-Brayfield M. Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery? J Pediatr Urol. 2017;13(1):45.e1-45.e4. doi:10.1016/j.jpurol.2016.09.011.
12. Zaidi RH, Casanova NF, Haydar B, Voepel-Lewis T, Wan JH. Urethrocutaneous fistula following hypospadias repair: regional anesthesia and other factors. Bosenberg A, editor. Pediatr Anesth. 2015;25(11):1144-1150. doi:10.1111/pan.12719
13. Fischer KM, Van Batavia J, Hyacinthe N, et al. Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair. J Pediatr Urol. 2023;19(4):374-379. doi:10.1016/j.jpurol.2023.03.019
14. Kim MH, Im YJ, Kil HK, Han SW, Joe YE, Lee JH. Impact of caudal block on postoperative complications in children undergoing tubularised incised plate urethroplasty for hypospadias repair: a retrospective cohort study. Anaesthesia. 2016;71(7):773-778. doi:10.1111/anae.13463
15. Saavedra-Belaunde JA, Soto-Aviles O, Jorge J, Escudero K, Vazquez-Cruz M, Perez-Brayfield M. Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery? J Pediatr Urol. 2017;13(1):45.e1-45.e4. doi: 10.1016/j.jpurol.2016.09.011
16. Hu JC, Belon C, Ravula NR, Durbin-Johnson B, Kurzrock EA. Impact of caudal block on revision rates after hypospadias repair: multi-institution review. J Pediatr Urol. 2023;19(3):292.e1-292.e7. doi:10.1016/j.jpurol.2023.02.004
17. Winberg H, Arnbjörnsson E, Anderberg M, Stenström P. Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture. Pediatr Surg Int. 2019; 35(11):1301-1308. doi:10.1007/s00383-019-04523-z
18. Karaca O, Pinar HU, Gokmen Z, Dogan R. Ultrasound-guided versus conventional caudal block in children: a prospective randomized study. Eur J Pediatr Surg. 2019;29(6):533-538. doi:10.1055/s-0038-1676980
19. Nanjundaswamy Nethra H, Nagappa, Saraswathi; Shridhara, Raghavendra Biligiri; Kalappa, Sandya. A comparative study of ultrasound-guided caudal block versus anatomical landmark-based caudal block in pediatric surgical cases. The Indian Anaesthetists Forum 21(1):p10-15, Jan-Jun 2020. doi:10.4103/TheIAForum.TheIAForum_73_19
20. Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, et al. Ultrasound-guided versus conventional injection for caudal block in children: a prospective randomized clinical study. J Clin Anesth. 2018;44:91-96. doi:10.1016/j.jclinane.2017.11.011
21. Ecoffey C, Lacroix F, Giaufre E, Orliaguet G, Courr eges P. Association des Anesthesistes Reanimateurs Pediatriques d’Expression Francaise (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20(12):1061e9
Article available in :
Volume 1, Issue 4, 2024
Page : 94-97
https://doi.org/10.51271/SOC-0022
Article Information
Received : 22 Eki 2024
Accepted : 14 Kas 2024
Published : 05 Ara 2024
Corresponding Author :

Gökhan Berktuğ Bahadır: Department of Pediatric Surgery, Gülhane Training and Research Hospital, Ankara, Turkiye

[email protected]
Citation : Erten E, Atasever HE, Korkmaz G, et al. Evaluation of the effect of preoperative caudal epidural block on early complications of hypospadias in distal hypospadias surgery. Surg Child. 2024;1(4):94-97.

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