# Monocryl® vs. Monocryl Plus® in Pediatric Reconstructive Urological Surgery: Outcomes of 653 Patients over 18 Years at a Single Centre

## TL;DR

This study found that antibiotic-coated sutures (Monocryl Plus) reduced surgical site infections and hospital stays in pediatric urological surgeries compared to regular sutures.

## Contribution

The study provides evidence that Monocryl Plus sutures reduce SSIs in pediatric urology, particularly in hypospadias repair.

## Key findings

- Monocryl Plus reduced surgical site infections (3.8% vs. 6.9%) compared to Monocryl.
- Hospital stays were shorter with Monocryl Plus (5 days vs. 6 days).
- Hypospadias repair showed significant benefits with Monocryl Plus, including fewer fistulas.

## Abstract

Background: Surgical site infection (SSI) remains a major concern in pediatric urological reconstructive surgery. Antibacterial-coated absorbable sutures like Monocryl Plus® have been introduced to reduce SSI, but evidence in pediatric populations is limited. This study aimed to compare outcomes between Monocryl® and Monocryl Plus® sutures in common pediatric urological procedures. Methods: A retrospective review was conducted of all children who underwent reconstructive urological surgery for hydronephrosis, vesicoureteral reflux (VUR), or hypospadias at the University Hospital of Split between January 2008 and December 2025. A total of 653 patients were included: 149 with hydronephrosis, 187 with VUR, and 317 with hypospadias. Patients were grouped based on suture type (Monocryl® vs. Monocryl Plus®). The primary outcome was SSI within 30 days after surgery; secondary outcomes included overall complications, reoperations, readmissions, and length of hospital stay. Results: SSI occurred less frequently with Monocryl Plus than with Monocryl (3.8% vs. 6.9%, p = 0.04). The median length of stay was shorter in the Monocryl Plus group (5 days, IQR 4–7) compared to Monocryl (6 days, IQR 5–8; p = 0.02). Overall complication rates were 6.1% vs. 10.0% (p = 0.07), early complications 4.6% vs. 8.0% (p = 0.06), and late complications 2.3% vs. 4.2% (p = 0.18), favouring Monocryl Plus but without statistical significance. Reoperation was required in 1.8% vs. 3.4% (p = 0.19), and readmission in 2.6% vs. 5.0% (p = 0.12). Subgroup analysis showed minimal differences in hydronephrosis (all p > 0.6), modest reductions in VUR (SSI 8.1% vs. 4.4%, p = 0.21), and significant differences in hypospadias (SSI 7.8% vs. 4.2%, p = 0.04; fistula 12.2% vs. 6.5%, p = 0.03). Multivariate regression confirmed Monocryl Plus as independently associated with lower odds of SSI (OR 0.55, 95% CI 0.30–0.98, p = 0.04) and prolonged hospitalization >7 days (OR 0.59, 95% CI 0.38–0.91, p = 0.02). Conclusions: In pediatric urological reconstructive surgery, Monocryl Plus sutures were associated with significantly fewer SSIs and shorter hospital stays compared to traditional Monocryl. Although the overall complication, reoperation, and readmission rates showed nonsignificant trends favouring Monocryl Plus, the most notable benefits appeared in hypospadias repair, suggesting that suture choice might influence outcomes in this subgroup.