Effects of caudal versus penile block on the incidence of hypospadias complications following primary repairs: A prospective, double-blind, randomized controlled trial.

INTRODUCTION

This prospective, randomized, double-blinded study aimed to compare the incidence of postoperative complications and perioperative analgesic efficacy between caudal and penile block in children undergoing primary hypospadias repair.

METHODS

Sixty-two boys aged 6-48 months were randomly assigned to receive either caudal block group (CB, n = 31) or penile block group (PB, n = 31) for preemptive analgesia before surgery. All patients underwent tubularized incised plate urethroplasty. The primary outcome was the incidence of postoperative complications, including urethrocutaneous fistula and meatal stenosis, assessed at 3- and 6-months post-surgery. Secondary outcomes included total perioperative fentanyl consumption and the number of patients requiring rescue analgesia.

RESULTS

There were no significant differences in the incidence of total complications (9.7 % vs. 16.1 %, p = 0.449), fistula (6.5 % vs. 3.2 %, p = 0.554), or meatal stenosis (3.2 % vs. 12.9 %, p = 0.162) between the CB and PB groups. However, fistula rate was significantly higher in patients with midpenil compared to distal hypospadias (13 % vs. 0 %, p = 0.021). Total perioperative fentanyl consumption and the number of patients requiring rescue analgesia were significantly lower in the CB group (p = 0.041 and p = 0.01, respectively).

CONCLUSION

In conclusion, caudal block provides superior perioperative analgesia without increasing the risk of postoperative complications compared to penile block in children undergoing primary hypospadias repair.

LEVEL OF EVIDENCE: Level I.