Is there a role for prophylactic antibiotics after stented hypospadias repair?

Data are lacking on prophylactic oral antibiotic use in stented hypospadias repair cases. We evaluated the role of prophylactic oral antibiotics for preventing symptomatic urinary tract infections in this population.

We reviewed consecutive patients treated with stented primary/redo hypospadias repair by a single surgeon from September 2009 to January 2012. All patients received antibiotics upon induction. Before April 1, 2011, patients also received prophylactic oral antibiotics while stented. They were compared to those who underwent surgery after April 1, who received no prophylactic oral antibiotics. The primary outcome was symptomatic urinary tract infections, as captured from patient records and verified by an electronic cross-check of ICD-10 codes. Secondary outcomes included cellulitis, fistula, dehiscence and meatal stenosis.

Of the 161 patients reviewed 11 were unstented and 1 underwent followup elsewhere. Of the remaining 149 patients 78 received prophylactic oral antibiotics and 71 did not. The groups were well matched for age, hypospadias characteristics, surgical technique and stent duration. Median followup was 17 months (range 0.2 to 33). No culture proven, symptomatic urinary tract infections developed in either group. One patient in the prophylactic group was treated for cellulitis by the pediatrician. The complication rate, including redo cases, was 18.2% in the prophylactic group and 15.3% in the nonprophylactic group (p = 0.8).

When postoperative prophylactic oral antibiotics were not administered, we identified no increased incidence of symptomatic urinary tract infections or complications. Our data suggest that prophylactic oral antibiotics may not be needed in cases of stented hypospadias repair. This study contributes to the growing body of evidence supporting the rational use of antimicrobials. It can potentially serve as a basis for a prospective, multicenter, randomized study.