Re: Urethrocutaneous Fistula following Hypospadias Repair: Regional Anesthesia and Other Factors

Abstract

available at http://www.ncbi.nlm.nih.gov/pubmed/26279102 Editorial Comment: The authors reviewed all boys with primary proximal hypospadias who underwent reconstruction between 2003 and 2013. Of 140 patients available for review 57 had undergone tubularized incised plate (TIP) repairs, 23 dorsal inlay grafts (DIGs) and 60 staged repairs. Reoperative rates for TIP and DIG techniques were 52.6% and 52.1%, respectively. Urethrocutaneous fistulas were seen in 31.5% and 13% of TIP and DIG techniques, respectively. Staged repair accomplished better results than TIP or DIG technique, despite being performed in the most unfavorable cases (reoperative rate 28%). It is refreshing to see many of our colleagues reporting honest results in proximal hypospadias repairs. These results, from a program known for a strong heritage of surgical excellence, are sobering and may be the new “gold standard” following proximal repairs. Douglas A. Canning, MD Re: Urethrocutaneous Fistula following Hypospadias Repair: Regional Anesthesia and Other Factors R. H. Zaidi, N. F. Casanova, B. Haydar, T. Voepel-Lewis and J. H. Wan Departments of Anesthesiology and Urology, University of Michigan, Ann Arbor, Michigan Paediatr Anaesth 2015; 25: 1144e1150. doi: 10.1111/pan.12719 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26201497 PEDIATRIC UROLOGY 1109 Editorial Comment: This series of 45 cases randomly selected from a database of 1,647 hypospadias procedures performed between 1994 and 2013 showed no significant differences in fistula rates when comparing hypospadias repair to caudal or penile block. Fistula was associated with a more proximal urethral meatus, longer operating time and use of subcutaneous epinephrine. This study refutes an earlier report from Kundra et al suggesting a higher rate of fistula in children undergoing caudal or epidural anesthesia compared to penile block. Douglas A. Canning, MD 1. Kundra P, Yuvaraj K, Agrawal K et al: Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Paediatr Anaesth 2012; 22: 707.