BACKGROUND: While traditionally perioperative antibiotics are administered at hypospadias surgery, previous studies have suggested no difference in outcomes. Our department as a quality improvement initiative opted to stop perioperative antibiotic administration for distal hypospadias surgery in January 2020. We hypothesized that antibiotics would not decrease the complication rate in our urban setting.
METHODS: After obtaining IRB approval, we retrospectively reviewed patients undergoing midshaft to distal hypospadias repair between January 2016 and November 2022. Patients who failed to follow up and those undergoing proximal hypospadias or fistula repairs were excluded, as were patients who received antibiotics after 2020. Dartos flaps were performed on all patients who underwent urethroplasty. Data points included: age at surgery, type of repair, location of meatus, chordee repair, presence of Byars flaps, stent type, use of anticholinergics, use of perioperative antibiotics, and complications. Of note, Kendall-Dover stents became unavailable at our institution during 2020. Patients receiving antibiotics were compared to those who did not with the student’s t-test, chi square, and Fisher’s exact probability test.
RESULTS: Of the 209 patients who met study criteria, 134 received antibiotics (ABx) while 75 did not (NABx). There was no difference mean age at time of surgery (20.2±2.9 vs 19.8±3.4 months, p=0.923). No differences between the groups were identified by meatus location, chordee repair, and use of Byars flaps, anticholinergics, or dressing duration. More patients receiving ABx had Kendall stents (44.0% vs 29.3%, p = 0.002), and their stents remained in for a shorter duration (3.5±0.2 vs 4.0±0.2 days, p=0.043). While it did not reach statistical significance, there may have been more patients undergoing MAGPI in the NABx group (22.7% vs 12.7%, p=0.08). There was no difference in the overall complication rate (21.6% ABx vs 16.0% NABx, p=0.325). Complications are presented in the table. Of note, there was no glans dehiscence, and there was only one episode of retention in a patient receiving antibiotics. All fistulae occurred in patients undergoing a tubularized incised plate repair. Subgroup analysis revealed no difference in fistulae between patients undergoing tubularized incised plate repair who received antibiotics and those who did not (p=0.731). There was also no difference in 30 day emergency room visits (4.5% ABx vs 2.7% NABx, p=0.513) or additional surgery (12.7% ABx vs 17.3% NABx, p=0.351). There was also no association between stent type and complications.
CONCLUSIONS: Although many factors can contribute to the likelihood of post-hypospadias repair complications, antibiotic usage does not seem to be one of them in our heterogeneous urban population, although longer follow up and future studies are warranted.
