• Patrick Pine Tanseco, Harkanwal Randhawa, Michael Erlano Chua, Udi Blankstein, Jin Kyu Kim, Melissa McGrath, Armando J Lorenzo, and Luis H Braga.
• Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines.
• Cuaj Can Urol Assoc. 2018 Dec 3: E249-E257.

IntroductionWe performed a meta-analysis of the current literature to assess the association of caudal block and postoperative complication rates following hypospadias repair.MethodsA Systematic literature search was conducted on October 2017. Five reviewers independently screened, identified, and evaluated comparative studies assessing postoperative outcomes following hypospadias repair with and without caudal block. The incidence of post-surgical complications from each study was extracted for caudal block and control groups to generate the odds ratio (OR) and corresponding 95% confidence intervals (CI). Effect estimates were pooled using inverse-variance method with random-effects model. Subgroup analyses were performed according to study type and hypospadias severity.ResultsNine studies (2096patients) of low- to moderate-quality were included for meta-analysis. Overall pooled effect estimates demonstrated increased occurrence of postoperative complication rates among patients with caudal block (OR 2.32; 95% CI 1.29-4.16). Subgroup analysis according to hypospadias severity revealed that a significant increased OR in complication rate was noted among proximal hypospadias (OR 3.55; 95% CI 1.80-7.01), but not distal hypospadias (OR 1.31; 95% CI 0.59-2.88).ConclusionsOur meta-analysis of poor-quality evidence may have revealed a significant association between caudal block and postoperative complications following hypospadias repair. However, subgroup analysis demonstrated that hypospadias severity is important in determining complication rates, suggesting that confounding factors and selection bias may play a central role in characterizing the true effect of the anesthesia approach.

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