Hypospadias severity solely predict postoperative complications
Complications following hypospadias repair are significantly associated with hypospadias severity only and not the type of regional anaesthesia, a recent study has found.
Researchers retrospectively reviewed the records of 849 consecutive patients who underwent tubularized incised plate repair between 2004 and 2015, and excluded 331 cases with incomplete medical records, other techniques and redo repair.
The analysis included age at surgery, meatal location, preoperative testosterone stimulation, degree of ventral curvature, surgeon expertise, complications (urethrocutaneous fistula/glans dehiscence) and type of regional anaesthesia (caudal block vs dorsal penile block). Anaesthesiologist discretion was the basis of preference for caudal block.
Of the 518 patients (median age at surgery, 18 months), 405 (78 percent) had distal and 113 (22 percent) had mid shaft/proximal defects. Median follow-up was 6 months.
A total of 37 cases (7 percent) developed complications, including urethrocutaneous fistula in 21 (19 with a caudal block and 2 with a dorsal penile block) and glans dehiscence in 16 (13 with a caudal block and 3 with a dorsal penile block).
Univariate analysis showed that complications were more common in preoperative testosterone stimulation vs no preoperative testosterone stimulation (13 vs 6.2 percent of cases; p=0.04), mid shaft/proximal vs distal defects (15.9 vs 4.7 percent; p<0.01), and caudal block vs dorsal penile block (8.7 vs 3.3; p=0.03).
Multivariate analysis, on the other hand, revealed that complications were not significantly associated with preoperative testosterone stimulation (odds ratio [OR], 1.2; 95 percent CI, 0.4 to 3.7) and caudal block (OR, 2.4; 0.9 to 6.4). Only the combination of meatal location/ventral curvature remained as an independent predictor for urethrocutaneous fistula/glans dehiscence (OR, 2.4; 1.1 to 5.7; p=0.04).
Researchers suggested the need for a well-powered, randomized, controlled trials to confirm these findings and provide strong and definitive evidence on this topic.