Abstract

Objective: Hypospadias is defined as incomplete closure of the penile structures during embryogenesis. Surgical correction induces various complications, including urethrocutaneous fistula (UCF). The aim of this study was to determine the risk factors for the occurrence of UCF in children undergoing hypospadias repair under caudal anesthesia.

Method: The medical records of children undergoing hypospadias repair between January 2013 and July 2018 were included. Data on patients’ age, body weight, height, type of repair procedure, type of hypospadias, duration of surgery, and hospitalization, and postoperative complications were analyzed.

Results: The mean age of the 122 patients was 4.8±3.7 years. The type of surgery performed was tubularized incised plate urethroplasty (Snodgrass) in 90 (73.8%) and meatal advancement and glanuloplasty (MAGPI) in 32 (26.2%) children. Sixteen (13.1%) children had postoperative complications, all of which were UCF. No statistical association was found between postoperative UCF and patient variables. The most common complication of hypospadias repair is UCF, which occurs mostly in the immediate postoperative period.

Conclusion: Hypospadias repair can result in complications. UCF remains a significant problem in the postoperative period. All patients underwent caudal block and despite the previous literature, we experienced lower rates of penile engorgement and postoperative UCF. These results showed that there was no cause-and-effect relationship between the caudal block and UCF. We think that the development of a urethrocutaneous fistula is mostly related to surgical causes and well-designed, prospective, and controlled studies are required to elucidate this issue.

Keywords: Caudal block, hypospadias, penile engorgement, tissue edema, urethrocutaneous fistula

Copyright and license

Copyright © 2023 The author(s). This is an open-access article published by Aydın Pediatric Society under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Kara D, Erdem AO, Dilsiz Eker P, Mersinli B, Karaca Özkısacık S, Kurt Ömürlü I, et al. Is there a role for caudal anesthesia on postoperative urethrocutaneous fistula in children undergoing hypospadias surgery?. Trends in Pediatrics. 2023;4(3):155-160. https://doi.org/10.59213/TP.2023.18189

References

  1. van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr. 2017;176:435-41. https://doi.org/10.1007/s00431-017-2864-5
  2. Taicher BM, Routh JC, Eck JB, Ross SS, Wiener JS, Ross AK. The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth. 2017;27:688-94. https://doi.org/10.1111/pan.13119
  3. Chung JW, Choi SH, Kim BS, Chung SK. Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study. Korean J Urol. 2012;53:711-5. https://doi.org/10.4111/kju.2012.53.10.711
  4. Ayob F, Arnold R. Do caudal blocks cause complications following hypospadias surgery in children? Anaesthesia. 2016;71:759-63. https://doi.org/10.1111/anae.13490
  5. Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT. Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Paediatr Anaesth. 2012;22:707-12. https://doi.org/10.1111/j.1460-9592.2011.03702.x
  6. Riedmiller H, Androulakakis P, Beurton D, Kocvara R, Gerharz E; European Association of Urology. EAU guidelines on paediatric urology. Eur Urol. 2001;40:589-99. https://doi.org/10.1159/000049841
  7. el-Galley RE, Smith E, Cohen C, Petros JA, Woodard J, Galloway NT. Epidermal growth factor (EGF) and EGF receptor in hypospadias. Br J Urol. 1997;79:116-9. https://doi.org/10.1046/j.1464-410x.1997.22624.x
  8. Gapany C, Grasset N, Tercier S, Ramseyer P, Frey P, Meyrat BJ. A lower fistula rate in hypospadias surgery. J Pediatr Urol. 2007;3:395-7. https://doi.org/10.1016/j.jpurol.2006.12.003
  9. Zaidi RH, Casanova NF, Haydar B, Voepel-Lewis T, Wan JH. Urethrocutaneous fistula following hypospadias repair: regional anesthesia and other factors. Paediatr Anaesth. 2015;25:1144-50. https://doi.org/10.1111/pan.12719
  10. Kreysing L, Höhne C. A retrospective evaluation of fistula formation in children undergoing hypospadias repair and caudal anesthesia. Paediatr Anaesth. 2016;26:329-30. https://doi.org/10.1111/pan.12845
  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;13:45.e1-45.e4. https://doi.org/10.1016/j.jpurol.2016.09.011
  12. Braga LH, Jegatheeswaran K, McGrath M, et al. Cause and effect versus confounding-Is there a true association between caudal blocks and tubularized incised plate repair complications? J Urol. 2017;197:845-51. https://doi.org/10.1016/j.juro.2016.08.110
  13. Duckett JW. Hypospadias. Pediatr Rev. 1989;11:37-42. https://doi.org/10.1542/pir.11-2-37
  14. Duckett JW, Snyder HM 3rd. Meatal advancement and glanuloplasty hypospadias repair after 1,000 cases: avoidance of meatal stenosis and regression. J Urol. 1992;147:665-9. https://doi.org/10.1016/s0022-5347(17)37341-x
  15. Alsharbaini R, Almaramhy H. Snodgrass urethroplasty for hypospadias repair: a retrospective comparison of two variations of the technique. Journal of Taibah University Medical Sciences. 2014;9:69-73. https://doi.org/10.1016/j.jtumed.2013.10.002
  16. Sarac M, Bakal U, Tartar T, Canpolat S, Kazez A. Is stent type used in snodgrass method a factor in fistula formation? Niger J Clin Pract. 2018;21:1198-202. https://doi.org/10.4103/njcp.njcp_317_17
  17. Manzoni G, Bracka A, Palminteri E, Marrocco G. Hypospadias surgery: when, what and by whom? BJU Int. 2004;94:1188-95. https://doi.org/10.1046/j.1464-410x.2004.05128.x