Abstract：
This meta-analysis aimed to evaluate the difference in postoperative complications as urethrocutaneous fistula or glans dehiscence, in children undergoing primary hypospadias repair with caudal block (CB) versus non-caudal block (NCB).
Data were obtained from MEDLINE, Embase, Web of Science, and the Cochrane Library. Comparative studies of CB versus NCB were identified, with reports of complications published or presented until October 2022. Subgroup analyses were performed based on study type, meatal location (distal only), type of NCB, surgeon and technique, and concentration and dose of anesthetics.
Compared to the reference group of NCB, CB was not significantly associated with the development of complications following primary hypospadias repair (OR 1.40, 95 % CI 0.88-2.23). After adjusting for confounding factors, such as type of study(OR 1.51, 95%CI: 0.29-7.91), type of NCB[PB (OR 1.82, 95 % CI: 0.87-3.84), GA (OR 1.26, 95 % CI: 0.39-4.04)], meatal location (distal only) (OR 1.22, 95 % CI: 0.61-2.43), surgeon and technique (OR 1.37, 95 % CI: 0.59-3.14) and concentration and dose of anesthetics(OR 2.74, 95 % CI: 0.82-9.20), subgroup analyses revealed no significant association between CB and NCB (P > 0.05).
Previous studies have found a correlation between CB and increased incidence of postoperative complications (urethrocutaneous fistula or glans dehiscence) of hypospadias, but different literature have suggested that surgical technique, surgical duration and the severity of hypospadias, rather than CB, are closely related to the occurrence of complications. In order to reduce confounding factors, subgroup analyses were conducted. The results showed that no correlation could be found in postoperative complications and CB.
This meta-analysis compared the incidence of urethrocutaneous fistula or glans dehiscence in the CB and NCB groups for primary hypospadias repair in children, indicating that no clear correlation could be found in postoperative complications and CB. Subgroup analyses on study type, type of NCB, meatal location (distal only), surgeon and technique, and regional anesthetic concentration and dose supported this conclusion.
Data were obtained from MEDLINE, Embase, Web of Science, and the Cochrane Library. Comparative studies of CB versus NCB were identified, with reports of complications published or presented until October 2022. Subgroup analyses were performed based on study type, meatal location (distal only), type of NCB, surgeon and technique, and concentration and dose of anesthetics.
Compared to the reference group of NCB, CB was not significantly associated with the development of complications following primary hypospadias repair (OR 1.40, 95 % CI 0.88-2.23). After adjusting for confounding factors, such as type of study(OR 1.51, 95%CI: 0.29-7.91), type of NCB[PB (OR 1.82, 95 % CI: 0.87-3.84), GA (OR 1.26, 95 % CI: 0.39-4.04)], meatal location (distal only) (OR 1.22, 95 % CI: 0.61-2.43), surgeon and technique (OR 1.37, 95 % CI: 0.59-3.14) and concentration and dose of anesthetics(OR 2.74, 95 % CI: 0.82-9.20), subgroup analyses revealed no significant association between CB and NCB (P > 0.05).
Previous studies have found a correlation between CB and increased incidence of postoperative complications (urethrocutaneous fistula or glans dehiscence) of hypospadias, but different literature have suggested that surgical technique, surgical duration and the severity of hypospadias, rather than CB, are closely related to the occurrence of complications. In order to reduce confounding factors, subgroup analyses were conducted. The results showed that no correlation could be found in postoperative complications and CB.
This meta-analysis compared the incidence of urethrocutaneous fistula or glans dehiscence in the CB and NCB groups for primary hypospadias repair in children, indicating that no clear correlation could be found in postoperative complications and CB. Subgroup analyses on study type, type of NCB, meatal location (distal only), surgeon and technique, and regional anesthetic concentration and dose supported this conclusion.
摘要：
背景：这项荟萃分析旨在评估术后并发症如尿道皮瘘或龟头裂开的差异，在使用尾神经阻滞（CB）与非尾神经阻滞（NCB）进行原发性尿道下裂修复的儿童中。
方法：数据来自MEDLINE，Embase,WebofScience,还有Cochrane图书馆.确定了CB与NCB的比较研究，并在2022年10月之前发布或提交并发症报告。根据研究类型进行亚组分析，肉质位置（仅远端），NCB类型,外科医生和技术，麻醉剂的浓度和剂量。
结果：与NCB的参考组相比，CB与原发性尿道下裂修复后并发症的发生没有显着相关（OR1.40，95％CI0.88-2.23）。在调整混杂因素后，例如研究类型(OR1.51，95CI：0.29-7.91)，NCB类型[PB（OR1.82，95%CI：0.87-3.84），GA（OR1.26，95%CI：0.39-4.04）]，肉的位置（仅远端）（OR1.22，95%CI：0.61-2.43），外科医生和技术（OR1.37，95％CI：0.59-3.14）以及麻醉药的浓度和剂量（OR2.74，95％CI：0.82-9.20），亚组分析显示CB和NCB之间无显著相关性(P>0.05)。
结论：先前的研究发现，CB与尿道下裂术后并发症（尿道皮瘘或龟裂）发生率增加之间存在相关性，但是不同的文献表明手术技术，手术时间和尿道下裂的严重程度，而不是CB，与并发症的发生密切相关。为了减少混杂因素，进行了亚组分析.结果表明，术后并发症与CB无相关性。
结论：这项荟萃分析比较了儿童原发性尿道下裂修复的CB组和NCB组的尿道皮肤瘘或龟头裂开的发生率，提示术后并发症与CB无明显相关性。研究类型的亚组分析，NCB类型,肉质位置（仅远端），外科医生和技术，区域麻醉药浓度和剂量支持这一结论。
方法：数据来自MEDLINE，Embase,WebofScience,还有Cochrane图书馆.确定了CB与NCB的比较研究，并在2022年10月之前发布或提交并发症报告。根据研究类型进行亚组分析，肉质位置（仅远端），NCB类型,外科医生和技术，麻醉剂的浓度和剂量。
结果：与NCB的参考组相比，CB与原发性尿道下裂修复后并发症的发生没有显着相关（OR1.40，95％CI0.88-2.23）。在调整混杂因素后，例如研究类型(OR1.51，95CI：0.29-7.91)，NCB类型[PB（OR1.82，95%CI：0.87-3.84），GA（OR1.26，95%CI：0.39-4.04）]，肉的位置（仅远端）（OR1.22，95%CI：0.61-2.43），外科医生和技术（OR1.37，95％CI：0.59-3.14）以及麻醉药的浓度和剂量（OR2.74，95％CI：0.82-9.20），亚组分析显示CB和NCB之间无显著相关性(P>0.05)。
结论：先前的研究发现，CB与尿道下裂术后并发症（尿道皮瘘或龟裂）发生率增加之间存在相关性，但是不同的文献表明手术技术，手术时间和尿道下裂的严重程度，而不是CB，与并发症的发生密切相关。为了减少混杂因素，进行了亚组分析.结果表明，术后并发症与CB无相关性。
结论：这项荟萃分析比较了儿童原发性尿道下裂修复的CB组和NCB组的尿道皮肤瘘或龟头裂开的发生率，提示术后并发症与CB无明显相关性。研究类型的亚组分析，NCB类型,肉质位置（仅远端），外科医生和技术，区域麻醉药浓度和剂量支持这一结论。
