Effect of Caudal vs. Penile Block on the Incidence of Hypospadias Complications Following Primary Repairs: A Retrospective Cohort Study

Adam C. Adler, Arvind Chandrakantan, Andrew D. Lee, Chester J. Koh, Nicolette K. Janzen, Paul F. Austin

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


PURPOSE: Primary repair of hypospadias is associated with risk of complications, specifically urethrocutaneous fistula and glanular dehiscence. Caudal block may potentially increase the risk of these complications. Therefore, we studied the incidence of hypospadias complications in children who underwent correction at our institution having received either penile or caudal block.

MATERIALS AND METHODS: We analyzed all primary hypospadias repair cases from December 2011 through December 2018 at Texas Children's Hospital with a minimum of 1-year followup for the presence of complications: urethrocutaneous fistula and glanular dehiscence. Surgical (surgeon, operative time, block type, local anesthetic, meatal position) and patient (age at correction, prematurity) factors were additionally analyzed.

RESULTS: For the primary aim, 983 patients underwent primary hypospadias correction with a minimum of 1 year of postoperative followup data. There were 897 patients (91.3%) in which no complications were identified and 86 (8.7%) with either urethrocutaneous fistula (81) or glanular dehiscence (5). Of the 86 identified complications, 45/812 (5.5%) were distal, 41/171 (24%) were proximal (p <0.001) with a complication. Rate of complications was not associated with caudal block (OR 0.67, 95% CI 0.41-1.09; p=0.11). On univariable analysis, age (OR 1.12, 95% CI 1.04-1.20; p=0.04), surgical duration (OR 1.02; 95% CI 1.01-1.02; p <0.001), prematurity <32 weeks (OR 4.38, 95% CI 1.54-4.11 p <0.001) and position of meatus as proximal (OR 5.38 95% CI 3.39-8.53; p <0.001) were associated with an increased rate of complications. However, on multivariable analysis, associations of age (OR 1.13, 95% CI 1.05-1.22; p=0.001), surgery duration (OR 1.01, 95% CI 1.01-1.02; p <0.001) and meatal position (OR 3.85, 95% CI 2.32-6.39; p <0.001) were associated with increased rate of complications.

CONCLUSIONS: Our data suggest that meatal location, older age, extreme prematurity and surgical duration are associated with increased incidence of complications (urethrocutaneous fistula and glanular dehiscence) following hypospadias correction. Analgesic block was not associated with increased hypospadias complication risk.

Original languageEnglish (US)
Pages (from-to)1454-1459
Number of pages6
JournalThe Journal of urology
Issue number5
StatePublished - May 1 2021


  • anesthesia
  • fistula
  • hypospadias
  • penis
  • Hypospadias/surgery
  • Humans
  • Child, Preschool
  • Nerve Block/methods
  • Infant
  • Male
  • Penile Diseases/epidemiology
  • Penis/innervation
  • Sacrococcygeal Region
  • Incidence
  • Postoperative Complications/epidemiology
  • Adolescent
  • Cutaneous Fistula/epidemiology
  • Urethral Diseases/epidemiology
  • Retrospective Studies
  • Urinary Fistula/epidemiology
  • Child
  • Cohort Studies

ASJC Scopus subject areas

  • Urology


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