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Influence of caudal block on postoperative oliguria in infants undergoing bilateral ureteroneocystostomy: a retrospective analysis

 Hyun Jeong Lee  ;  Yong Seon Choi  ;  Bon‐Nyeo Koo  ;  Sang Won Han  ;  Young Eun Cho  ;  Young Jae Im  ;  Jae Hoon Lee 
 PEDIATRIC ANESTHESIA, Vol.27(7) : 695-701, 2017 
Journal Title
Issue Date
Anesthesia, Caudal/adverse effects* ; Antiemetics/adverse effects ; Cohort Studies ; Cystostomy/adverse effects* ; Dexamethasone/adverse effects ; Female ; Humans ; Incidence ; Infant ; Male ; Oliguria/epidemiology* ; Oliguria/etiology* ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Risk Factors ; Ureter/surgery* ; Urinary Catheterization ; Urodynamics ; Vesico-Ureteral Reflux/surgery
analgesia ; anesthesia ; caudal ; epidural ; infant ; oliguria ; urologic surgical procedures ; vesicoureteral reflux
BACKGROUND: Caudal block has been widely used in children undergoing genitourinary surgery. However, the influence of caudal block on postoperative oliguria is unclear.

AIM: The aim of this study was to assess the effect of caudal block on urinary flow through the reimplanted ureter after ureteroneocystostomy and the incidence of postoperative oliguria in infants.

METHODS: This retrospective study analyzed the medical records of 121 infants aged less than 12 months who underwent bilateral ureteroneocystostomy for vesicoureteral reflux at a tertiary medical center. In all study infants, a ureteral catheter was placed in one of the two ureters in order to relieve the clinical consequences of transient ureteral obstruction and a urethral catheter was placed at the end of the ureteroneocystostomy procedure. Urinary output was assessed separately for each catheter. Logistic regression analysis was performed to identify the risk factors for oliguria from the urethral catheter.

RESULTS: Among the 121 patients, 63 (52%) received caudal block (caudal block group) and 58 (48%) did not (no caudal block group). Patient characteristics, preoperative vesicoureteral reflux grade and renal function, and intraoperative profiles were comparable between the groups. The incidence of oliguria from the urethral catheter for 8 h after the surgery was significantly higher in the caudal block group than in the no caudal block group. However, the incidence of oliguria from the ureteral catheter was comparable between the groups. In multivariate analysis, oliguria from the urethral catheter was associated with caudal block, anesthesia duration, and intraoperative dexamethasone administration. The odds for oliguria was 3.069-fold greater in patients who received caudal block than in those who did not (95%CI, 1.303-7.228, P = 0.010). On the other hand, intraoperative dexamethasone reduced the risk of oliguria.

CONCLUSION: Caudal block may be associated with postoperative oliguria in infants undergoing ureteroneocystostomy.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Lee, Jae Hoon(이재훈) ORCID logo https://orcid.org/0000-0001-6679-2782
Lee, Hyun Jeong(이현정)
Joe, Young Eun(조영은) ORCID logo https://orcid.org/0000-0002-5848-5843
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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