Antibiotics or No Antibiotics after Urethroplasty For Hypospadias: An RCT Evaluating Short Term Surgical Outcomes

The use of prophylactic antibiotics after hypospadias repair is neither uniform nor evidence-based. This study is an effort to generate the evidence for association of prophylactic antibiotics on complications after urethroplasty for hypospadias.

It was a prospective randomized double-blinded controlled trial. The two groups underwent urethroplasty as per the choice of the surgeon. Group A received only a single antibiotic at induction and no antibiotics in the postoperative period, while Group B received antibiotics at induction and postoperatively for 10 days till the urethral stent was in situ. The outcomes were compared.

A total of 158 patients were included in the trial. The two groups were similar in their demographic (age, birth order, weight, height, and associated anomalies) and pathological (severity of hypospadias, meatal stenosis, stretched penile length, and chordee) parameters, and they underwent similar procedures. Group A children had higher urine culture positivity after catheter removal but there was no difference in the complications (symptomatic urinary tract infection, surgical site infection, urethra-cutaneous fistula, urethroplasty dehiscence, meatal stenosis, and urethral stricture) among the two groups.

Routine postoperative prophylactic antibiotics do not reduce surgical complications after urethroplasty for hypospadias repair. The use of prophylactic antibiotics may be avoided to reduce the incidence of antimicrobial resistance, reduce treatment costs, and prevent complications of antibiotic usage like Clostridium difficile infections.