Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
J Urol. 2021 May;205(5):1454-1459. doi: 10.1097/JU.0000000000001448. Epub 2020 Dec 21.
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.
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.
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.
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.
尿道下裂的初次修复与并发症的风险相关，特别是尿道皮肤瘘和龟头裂开。尾部阻滞可能会增加这些并发症的风险。因此，我们研究了在我们机构接受阴茎或尾部阻滞矫正的儿童中尿道下裂并发症的发生率。
我们分析了 2011 年 12 月至 2018 年 12 月在德克萨斯儿童医院接受初次尿道下裂修复的所有病例，至少随访 1 年，以确定是否存在并发症：尿道皮肤瘘和龟头裂开。另外分析了手术（外科医生、手术时间、阻滞类型、局部麻醉、尿道口位置）和患者（矫正时的年龄、早产）因素。
对于主要目的，983 例患者接受了初次尿道下裂矫正，至少有 1 年的术后随访数据。897 例（91.3%）患者未发现并发症，86 例（8.7%）有尿道皮肤瘘（81 例）或龟头裂开（5 例）。在 86 例已识别的并发症中，45/812（5.5%）为远端，41/171（24%）为近端（p<0.001）。并发症的发生率与尾部阻滞无关（OR 0.67，95%CI 0.41-1.09；p=0.11）。单变量分析显示，年龄（OR 1.12，95%CI 1.04-1.20；p=0.04）、手术时间（OR 1.02；95%CI 1.01-1.02；p<0.001）、早产<32 周（OR 4.38，95%CI 1.54-4.11 p<0.001）和尿道口位置为近端（OR 5.38 95%CI 3.39-8.53；p<0.001）与并发症发生率增加相关。然而，多变量分析显示，年龄（OR 1.13，95%CI 1.05-1.22；p=0.001）、手术时间（OR 1.01，95%CI 1.01-1.02；p<0.001）和尿道口位置（OR 3.85，95%CI 2.32-6.39；p<0.001）与并发症发生率增加相关。
我们的数据表明，尿道口位置、年龄较大、极早产和手术时间与尿道下裂矫正后并发症（尿道皮肤瘘和龟头裂开）的发生率增加有关。镇痛阻滞与尿道下裂并发症风险增加无关。
