Is There a Role for Prophylactic Antibiotics after Stented Hypospadias Repair?

Kanaroglou, Niki; Wehbi, Elias; Alotay, Abdulhakim; Bägli, Darius; Koyle, Martin A.; Lorenzo, Armando J.; Farhat, Walid A.

doi:10.1016/j.juro.2013.02.015

Cited by 29 publications

(26 citation statements)

References 14 publications

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“…Growing evidence demonstrates that postoperative antibiotics may not be needed for stented repair. 13 Congruent with our data, Kanaroglou and colleagues did not have any cases of symptomatic UTI, reasserting that infectious complications from hypospadias have a low incidence.…”

Section: Discussionsupporting

confidence: 80%

The role of preoperative prophylactic antibiotics in hypospadias repair

Baillargeon

Duan²,

Brzezinski³

et al. 2014

CUAJ

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Introduction: We sought to determine whether the use of preoperative antibiotics is effective in reducing postoperative wound infections and urinary tract infections (UTI) in hypospadias repair. Methods:We retrospectively reviewed all hypospadias repairs performed at the Montreal Children's Hospital between March 2009 and September 2012. All types of primary hypospadias repairs and redo cases were included. Patients with no adequate follow-up or with missing records of antibiotics were excluded. Preoperative antibiotics were given in the form of cefazolin (50 mg/kg intravenously) when appropriate. Postoperative oral antibiotics were administered as decided by the pediatric urologist. Primary outcomes included postoperative wound infection and UTI. Secondary outcomes included the need for reoperation of hypospadias due to urethrocutaneous fistula, meatal stenosis, urethral stricture and wound dehiscence. Results: In total, 157 cases of hypospadias repair were reviewed; of these 7 were excluded due to lack of follow-up. Of the remaining 150 patients, 62 received preoperative antibiotics and 88 did not. The groups were well-matched for age, hypospadias characteristics, type of repair and repair of curvature. The group that received preoperative antibiotics had a significantly higher number of stented cases (82% vs. 52% of the non-preoperative antibiotic group). Two cases of wound infection were reported (1 in the preoperative antibiotic group and 1 in the non-preoperative antibiotic group). There was no symptomatic UTI or culture-demonstrated UTI in either group. Moreover, there was no statistically significant difference between the 2 groups in terms of primary outcomes. The complication rate was 11% (17/150 repairs) and all patients needed reoperation. This study's important limitations include the rarity of studied end points combined with the small sample and the retrospective nature of our study. Conclusion: Our findings do not support the routine use of preoperative antibiotics in hypospadias repair.

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Section: Discussionsupporting

confidence: 80%

The role of preoperative prophylactic antibiotics in hypospadias repair

Baillargeon

Duan²,

Brzezinski³

et al. 2014

CUAJ

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“…Therefore, the use of prophylaxis was opposed because it did not decrease the number of infections related to the hypospadias procedure. 4,17 We only registered symptomatic UTIs confirmed by positive urine cultures. Therefore, our study design is more similar to the latter two studies mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Urinary Tract Infection in Boys with Hypospadias

Winberg

Jinhage

Träff

et al. 2016

MOJS

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The aim of this study was to evaluate the frequency of urinary tract infections (UTI) in boys with hypospadias pre-peri-and post-operatively in order to determine whether antibiotic prophylaxis for UTI is warranted when they undergo a reconstructive surgery for hypospadias. Included in the study group were 174boys undergoing reconstructions for hypospadias. The control group comprised 204 boys operated on for an inguinal hernia. The main outcome measure was the documented finding of a urinary tract infection verified by a positive bacteria culture. The results revealed a significant difference in the findings of a positive urinary culture between the boys undergoing hypospadias surgery, 7.5%, and those operated on for an inguinal hernia, 1.5%, (p=0.0044). The difference between the groups was not significant in the preand peri-operative periods. A higher incidence of infections was noted in boys who had other congenital malformations in addition to hypospadias (P=0.02). Thus, the boys with hypospadias are more likely to incur a urinary tract infection. Since the results did not show a higher incidence of symptomatic urinary tract infections shortly after the surgery, it may not be advantageous to administer prophylactic antibiotics to decrease the number of urinary tract infections. However, comparison of subgroups consisting of the hypospadias without and with prophylactic antibiotics remains to be conducted.

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“…This is, however, unlikely as recurrent UTIs usually cause significant distress to both child and parents and will be somehow captured along the clinical course and follow‐up. Given the paucity of tertiary pediatric centres within the catchment area and our high rate of follow‐up post‐hypospadias (reported to be as high as 96% in some series ) we believe that most patients who developed recurrent UTIs would have been identified at either regular follow‐up visits, or through referral in the acute setting. Nevertheless, we acknowledge that missed UTIs could be a limitation to our study.…”

Section: Discussionmentioning

confidence: 99%

Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair

et al. 2014

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E.W. and P.P. contributed equally to this manuscript Objective• To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair. Materials and Methods• We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. • Data on age, operating details, postoperative complications and imaging studies were collected.• We attempted to identify risk factors for recurrent UTIs after hypospadias repair. Results• During the study period, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years.• Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs.• Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted.• Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively. Conclusions• The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure.• Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities.

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Is There a Role for Prophylactic Antibiotics after Stented Hypospadias Repair?

Cited by 29 publications

References 14 publications

The role of preoperative prophylactic antibiotics in hypospadias repair

The role of preoperative prophylactic antibiotics in hypospadias repair

Urinary Tract Infection in Boys with Hypospadias

Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair

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