Related Experiment Video
Updated: Feb 17, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
A meta-analysis: postoperative prophylactic antibiotics compared with non-antibiotics for pediatric hypospadias
Fengming Ji1, Hongjing Jiang2, Yihong Li3
1Urology Surgery Department of the Children's Hospital of Kunminng Medical University, Kunming Chlidren's Hospital, Key Laboratory of Children's Major Disease Research, Kunming, Yunnan, China.
Insights
Postoperative prophylactic antibiotics (PA) significantly reduced urinary tract infections (UTI) after hypospadias surgery but did not impact other complications. Routine PA use should be reconsidered for individualized approaches.
Area of Science:
- Urology
- Pediatric Surgery
- Infectious Diseases
Background:
- Hypospadias repair is a common pediatric urological surgery.
- The use of postoperative prophylactic antibiotics (PA) after hypospadias repair is debated.
- Evidence is needed to guide the rational application of PA in this context.
Purpose of the Study:
- To evaluate the impact of postoperative prophylactic antibiotics (PA) on complications following hypospadias surgery.
- To provide evidence for clinical decision-making regarding PA use.
- To promote rational antibiotic stewardship in pediatric hypospadias repair.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) published from 2000 to present.
- Studies compared postoperative PA versus no PA in hypospadias surgery patients.
- Data were analyzed using RevMan 5.4 and STATA 18.0 to determine odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Seven studies involving 862 participants were included (5 RCTs, 2 NRCTs).
- Postoperative PA significantly reduced the incidence of urinary tract infections (UTI) (p=0.004).
- No significant differences were found in overall complications, fistula, meatal stenosis, symptomatic UTI, surgical site infection, dehiscence, or diverticulum rates.
Conclusions:
- Postoperative prophylactic antibiotics significantly decrease UTI incidence after pediatric hypospadias repair.
- The observed reduction in UTI may be largely due to asymptomatic bacteriuria, limiting clinical relevance.
- Routine postoperative PA use is questionable; individualized, risk-stratified strategies are recommended.
Objective:
This study evaluated the impact of postoperative prophylactic antibiotics (PA) use on complications after hypospadias surgery, to guide clinical diagnosis and treatment, as well as promote the rational application of PA.
Method:
Through computer searches of PubMed, EMbase and Cochrane Library, randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) on the postoperative PA for hypospadias from the year 2000 to the present were included. The included studies divided the subjects into antibiotics and non-antibiotics groups based on whether PA was used postoperatively. Data analysis was performed using RevMan 5.4 and STATA 18.0 software, determining the odds ratio (OR) and 95% confidence interval (CI) through fixed-effect or random-effect models.
Results:
A total of seven studies were included in the research, comprising five RCT and two NRCT, involving 862 participants. Among these, 462 participants received antibiotics, with 53 experiencing complications. Two hundred and fifty-nine participants did not receive antibiotics, with 31 experiencing complications. The results of the meta-analysis indicated that there was a significant difference in the incidence of urinary tract infections (UTI) between the antibiotics group and the non-antibiotics group (p = 0.004), while there were no differences in the rates of overall complications (OC) (p = 0.61), fistula (p = 0.96), meatal stenosis (MS) (p = 0.40), symptomatic UTI (sUTI) (p = 0.55), SSI (p = 0.47), dehiscence (p = 0.27), and diverticulum (p = 0.98).
Conclusion:
This meta-analysis demonstrated that postoperative PA significantly reduced the incidence of UTI following pediatric hypospadias repair. However, no significant benefits were observed for OC, fistula, MS, sUTI, SSI, dehiscence, or diverticulum. The clinical relevance of this UTI reduction may be limited as it primarily reflects decreased asymptomatic bacteriuria rather than symptomatic infections. These findings suggest that routine postoperative PA use should be reconsidered, and individualized, risk-stratified approaches are needed.
Related Concept Videos
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care