Is antibiotic prophylaxis warranted in hypospadias repairs?
Reviewed by Neil Featherstone

Hypospadias repair is a common paediatric urological procedure. Complication rates following hypospadias repair are variable (ranging from 5–10% for distal hypospadias repairs and as high as 32–70% for proximal repairs). Limiting surgical site infections by minimising infection through antibiotic prophylaxis can potentially reduce postoperative complications. However, growing rates of antibiotic resistance have been noted and a need for antibiotic stewardship is required. Some recent studies have challenged the belief that antibiotics are essential for preventing complications in hypospadias repairs. Here the authors evaluate the association of preoperative antibiotic prophylaxis in preventing postoperative complications following hypospadias repairs using a National Surgical Quality Improvement Programme (NSQIP) paediatric registry (data from 2021–2022). Over 7600 cases of hypospadias repair were retrospectively analysed. Information was gathered from more than 600 hospitals. Preoperative antibiotic usage was high at 84%. However, the 30-day rate of postoperative urinary tract infection (UTI) and wound dehiscence / infection was low (approximately 3%). Multivariable analysis showed that receiving antibiotic prophylaxis was not associated with a decrease in wound complications nor UTIs. However, for longer surgeries, the use of preoperative antibiotics had a protective association against wound complications. The authors acknowledge that their study was retrospective and potentially susceptible to selection bias. The database also was missing data regarding the degree of hypospadias, rationale for preoperative antibiotic prophylaxis, postoperative antibiotic use and the use of urethral stents / catheters. Follow-up was also limited to a 30-day period and thus certain complications such as fistulas or strictures may not be noted. The data suggests that given the overall incidence of postoperative complications is low, surgeons could consider omitting preoperative antibiotics in lower risk patients undergoing simple hypospadias repairs.  

Utility of preoperative antimicrobial prophylaxis in hypospadias repair: results from National Surgical Quality Improvement Program Pediatric Registry.
Basin M, Gopalakrishnan M, Ackerman N, et al.
JOURNAL OF UROLOGY
2025;214:210–18.