Do Perioperative Antibiotics Improve Outcomes After Hypospadias Repair? A Systematic Review and Meta-Analysis of Pediatric Literature

TL;DR

Using antibiotics before or after hypospadias surgery does not reduce complications, suggesting routine use is unnecessary.

Contribution

A systematic review and meta-analysis clarifies that routine perioperative antibiotics offer no benefit in hypospadias repair.

Findings

Perioperative antibiotics do not significantly reduce infectious complications after hypospadias repair.

Combined pre- and postoperative antibiotics show no clear benefit over no antibiotics.

A selective, risk-based antibiotic strategy is recommended to support antimicrobial stewardship.

Abstract

What are the main findings?
Perioperative antibiotics do not significantly reduce postoperative complications after hypospadias repair.No clear benefit was observed for preoperative, postoperative, or combined antibiotic regimens.

Perioperative antibiotics do not significantly reduce postoperative complications after hypospadias repair.

No clear benefit was observed for preoperative, postoperative, or combined antibiotic regimens.

What are the implications of the main findings?
Routine antibiotic use in hypospadias surgery may be unnecessary.A selective, risk-based antibiotic strategy supports antimicrobial stewardship without compromising outcomes.

Routine antibiotic use in hypospadias surgery may be unnecessary.

A selective, risk-based antibiotic strategy supports antimicrobial stewardship without compromising outcomes.

Background/Objectives: The role, timing, and duration of antibiotic therapy in hypospadias repair remain controversial, with substantial variability in clinical practice and a lack of evidence-based guidelines. This systematic review and meta-analysis aimed to evaluate whether preoperative, postoperative, or combined perioperative antibiotic regimens influence postoperative outcomes after hypospadias repair. Methods: A systematic literature search of PubMed, MEDLINE, Scopus, Embase, and Web of Science was conducted in accordance with PRISMA guidelines to identify studies published between 2000 and 2025 that reported on perioperative antibiotic administration in pediatric patients undergoing hypospadias surgery. Three comparisons were assessed: (i) postoperative antibiotics versus no antibiotics, (ii) preoperative antibiotics versus no antibiotics, and (iii) combined pre- and postoperative antibiotics versus no antibiotics. Outcomes included infectious complications, wound dehiscence, urethrocutaneous fistula, meatal or urethral stenosis, and other postoperative complications. Random-effects meta-analyses were performed, with pooled odds ratios reported together with 95% confidence intervals. Results: Ten studies comprising a total of 9493 patients were included. Perioperative antibiotic use was not associated with a significant reduction in infectious complications (OR 0.95, 95% CI 0.63–1.44; p = 0.81), urethrocutaneous fistula (OR 1.89, 95% CI 0.87–4.12; p = 0.10), or wound dehiscence (OR 1.52, 95% CI 0.98–2.35; p = 0.06) compared with no antibiotic use. Preoperative antibiotic prophylaxis alone did not result in a reduction in infectious complications or wound dehiscence. Combined pre- and postoperative antibiotic therapy did not demonstrate a clear benefit over no antibiotics in terms of infectious complications, although available data were very limited. Conclusions: Routine perioperative antibiotic therapy does not significantly reduce postoperative complications after hypospadias repair. These findings support a selective, risk-based approach to antibiotic use rather than routine administration in hypospadias surgery. Further well-designed prospective studies are needed to establish evidence-based perioperative antibiotic protocols in pediatric hypospadias surgery.

Figures