Does caudal block increase the incidence of urethrocutaneous fistula formation following hypospadias repair in infants? A multi-center prospective randomized trial

Caudal blockade is the most commonly performed regional anesthetic in children and has been shown to have a high degree of safety. Large prospective studies in infants and young children have shown that serious anesthetic complications such as local anesthetic toxicity, nerve injury, or infection are very rare, occurring in less than 0.003% of cases. Several recent studies, however, have suggested that in children who undergo repair of hypospadias (a common birth defect where the urethra- the tube that carries urine from the bladder- exits the penis in the middle of the shaft instead of at its tip), a possible relationship exists between caudal blockade and the development of postoperative urethrocutaneous fistula formation. a fistula is a breakdown of the repair where a communication develops between the urethra and the skin. other retrospective studies, however, have found no relationship. our research question is whether the administration of a caudal block increases the incidence of urethrocutaneous fistula formation in infants following hypospadias repair. We will study this by randomizing infants who need this operation to receive either a caudal block or a penile nerve block, and following them to see if there is a difference in the number who form fistulas.