For a study, researchers sought to investigate the relationship between the kind of analgesic block and the likelihood of problems after primary hypospadias treatment.
Data were gathered from MEDLINE, Embase, Web of Science, and the Cochrane Library as of January 1, 2021. Randomized clinical trials, cohort studies, and case-control studies presented original data on children less than 18 who had primary hypospadias treatment with either a penile or caudal block and for which outcomes (urethrocutaneous fistula or glans dehiscence) were recorded. Data extraction and inclusion quality assessments were done separately by two investigators.
Based on the block used, the main result was the frequency of complications six months after surgery. There were 10 trials (3,201 patients; range: 54-983). The caudal block was preferred in 4 trials (cumulative weight 71.4%) compared to the penile block in 6 studies (cumulative weight 28.6%). Caudal blocks did not significantly increase the risk of problems after primary hypospadias correction (relative risk 1.11, 95% CI (0.88, 1.41); P=.38) as compared to the reference group of penile blocks. In comparison to the reference group, caudal blocks for primary hypospadias correction did not significantly increase the risk of developing fistulae or glanular dehiscence when compared to penile blocks for distal (relative risk 1.46, 95% CI (0.98, 2.17); P=.065); and proximal (relative risk 0.95, 95% CI (0.58, 1.54); P=.823) or proximal (relative risk 0.95, 95% CI (0.58, 1.54); P=.823).
Following primary hypospadias treatment in children, the risk of sequelae was not correlated with the kind of analgesic block. Therefore, for these urological treatments, the caudal block must be considered.