Evidence supporting post operative prophylactic oral antibiotics (POA) in routine stented hypospadias repair is lacking. In light of emerging resistance patterns, drug side effects, parental anxiety and rising health care costs, we seek to clarify the role of POA in preventing post operative infection in this population.
After ethics board review, we prospectively collected data on all consecutive patients undergoing stented primary or redo hypospadias repair by a single surgeon from Jan 2010 – Jan 2012. All patients received single-dose intravenous antibiotics on induction of anesthesia. Prior to April 1, 2011 all patients received POA for the duration of stenting. We compared this group to the non-POA group (surgery after April 1), who received only single-dose antibiotics on induction. The primary outcome was urinary tract infection (UTI) defined by positive urine culture. Infection rates were captured by patient history, and by reviewing all hospital visits and laboratory results available at our institution. Secondary outcomes included rates of skin infection, fistula, dehiscence and meatal stenosis.
During this period, 132 patients underwent hypospadias repair, 118 of which were stented (median 7 days (1-12)). No patient was lost to follow up. Median age at surgery was 28.3 months (8-215). 110 were primary repairs, and 8 were redo operations. In the primary repair group, techniques used were tubularized incised plate (85%), staged (7%), glanular approximation (5%), and other (3%). 56 (47%) received POA, and 62 (53%) had no POA. Patients in both groups were statistically well matched for age, location of meatus, presence of chordee, use of testosterone, type of repair, and duration of stenting.
No culture proven UTIs occurred in either group. 3 patients in the POA group were reported to have UTI by parent history, but 2 of these were treated empirically without culture by their pediatrician, and 1 had a negative culture. No patients in either group had documented skin infection. The overall complication rate was 2.3% in the POA group, and 1.3% in the non-POA group (p>0.5).
In our cohort, there was no clear difference in UTI or complication rates between the two groups. Within the limitations of this study design, our results suggest that POA may be unnecessary in stented hypospadias repair. A further prospective study is needed to clarify these risks and benefits.