The rate of urethrocutaneous fistula following caudal and penile blocks for hypospadias repair may be similar

1. No statistically significant difference in urethrocutaneous fistula incidence was found between caudal and penile blocks, though wide confidence intervals preclude ruling out clinically meaningful differences.

2. Caudal block offered superior perioperative analgesia with reduced opioid requirements, suggesting an analgesic advantage 

Evidence Rating Level: 1 (Excellent) 

Retrospective data on the relationship between caudal block and urethrocutaneous fistula (UCF) after hypospadias repair have been inconsistent, largely due to inadequate control for hypospadias severity. To address this, a multicenter, randomized, non-inferiority trial was conducted across 16 Pediatric Regional Anesthesia Network centers, enrolling children aged 2 years or younger undergoing primary single-stage midshaft or distal hypospadias repair. Patients were randomized to receive either a caudal block or a penile block in conjunction with general anesthesia. The primary endpoint was UCF formation within three months postoperatively, while secondary endpoints included perioperative opioid use and postoperative pain as measured by FLACC scores. Among 161 patients completing follow-up, UCF rates were similar between the caudal (8.9%) and penile (7.3%) block groups (RR 0.98, 95% CI 0.35–2.76, p=0.9), while proximal meatal position independently increased UCF risk. Patients receiving caudal blocks required significantly less intraoperative and rescue opioid administration and had lower PACU pain scores. The trial was terminated early due to incomplete enrollment and loss to follow-up, limiting the precision of these estimates.

Click here to read this study in Regional Anesthesia & Pain Medicine

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.