Penile nerve block tied to higher revision surgery rates after hypospadias repair

Penile nerve blocks (PNBs), rather than caudal epidural blocks (CEBs), may lead to higher rates of revision surgery after hypospadias repair, a recent study has found.

The study included 188 paediatric patients (mean age at surgery, 21.3±23.0 months) who underwent primary distal hypospadias repair. The outcome was revision surgery, defined as reoperation for fistulae, strictures, dehiscence, or meatal stenosis. Patient records were retrieved from a database at the Queensland Children’s Hospital.

Of the participants, 60.6 percent (n=114) received a PNB, while 39.4 percent (n=74) received a CEB. Over a median follow-up of 20 months, 31 revision surgeries were performed, corresponding to a rate of 16.5 percent.

The main indications for revision surgery included urethrocutaneous fistulae (9.0 percent), meatal stenosis or strictures (4.8 percent), and glans dehiscence (2.7 percent).

Unadjusted Cox regression analysis revealed that only PNB was a significant risk factor for revision surgery (hazard ratio [HR], 2.55, 95 percent confidence interval [CI], 1.04–6.27; p=0.04). Adjusting for confounders did not attenuate this interaction, instead even increasing the magnitude of its effect (HR, 2.74, 95 percent CI, 1.09–6.92; p=0.03). This analysis used CEB as a reference.

Other potential risk factors, such as age, surgeon training, type of surgery, and American Society of Anaesthesiologist grade, were all unrelated to revision surgery risk.

The researchers, however, pointed out that randomization was not performed, and therefore the study could not account for selection bias. In addition, the findings only apply to distal hypospadias repair, and complications may occur for midshaft and proximal repairs, as well as at older ages.