NEW ORLEANS, LA USA (UroToday.com) - Dr. John Wiener of Duke University presented one of the most anticipated abstracts of the meeting. The authors reviewed their institutional experience to assess whether caudal anesthesia was associated with a greater risk of complications after hypospadias repair. The outcomes of a single senior surgeon were retrospectively reviewed over a period between 2001-2014. Staged surgeries or complex hypospadias cases were excluded. Patient records were reviewed for multiple factors including intraoperative narcotic use, caudal anesthesia, and postoperative complications.
A total of 396 repairs were reviewed and these were performed at a median age of 12 months. 82% of the cases were distal and 18 % proximal hypospadias. Caudal anesthesia was used in 58% of these patients with the remaining undergoing a penile block.
Urethrocutaneous fistula and/or glans dehiscence occurred in 23 patients for a complication rate of 5.8%. Complication rates were associated with surgical duration and year in which they were performed (meaning the surgeon improved his outcomes over time). Complications were also more common in patients with a proximal native meatus.
When the results were analyzed, the outcomes were dramatic. Of the 9 distal repairs that developed a fistula, all of them had undergone caudal anesthesia. For proximal repairs, 13 of the 14 patients with a fistula had received a caudal. On multivariable logistic regression, caudal use was associated with odds ratio (OR) of 14.4 and a proximal location of the native meatus led to an OR of 7.5.
The authors postulated that venous pooling contributed to fistula development by reducing the perfusion of the neo-urethra in the immediate recovery period. However, the exact mechanisms by which caudal anesthesia contributes to these complications are unknown. A larger, multi-center study would be beneficial to validate this data. In the interim, the surgeons at Duke have decided to forgo caudal anesthesia during urethroplasty associated with hypospadias repair.
Presented by John Wiener at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Duke University, Durham, NC USA
Reported by Michaella M. Prasad, MD (Medical University of South Carolina, Charleston, SC USA), medical writer for UroToday.com