Perioperative antibiotic prophylaxis in the surgical treatment of hypospadias in children

Introduction. Hypospadias remains a relevant and challenging problem for surgeons. The rate of complications is still considerably high, with many authors reporting figures ranging from 10% to 50% or even more. Urinary tract infection (UTI) and surgical site infection (SSI) in the postoperative period are among the causes of long-term complications following hypospadias repair. However, according to a number of authors, SSI in hypospadias surgery is relatively rare. Consequently, with the recent increase in antibiotic resistance, the necessity of perioperative antibiotic prophylaxis for distal forms of hypospadias in children has been called into question. Objective: To evaluate the efficacy and advisability of perioperative antibiotic prophylaxis in the surgical treatment of distal hypospadias in children.

Materials and methods. A prospective randomized study was conducted from 2023 to 2025, involving 122 boys aged 1 to 3 years with distal hypospadias. The patients were divided into two equal groups of 61 patients each. Patients in group 1 received perioperative antibiotic prophylaxis for 3–5 days. Patients in group 2 did not receive antibiotic prophylaxis. All patients underwent urethroplasty using one of three techniques: MAGPI, Mathieu, or TIP. The primary outcome of the study was the presence of a SSI, defined as erythema, pronounced edema, or purulent discharge from the surgical wound, as well as UTI, manifested as pyuria and bacteriuria. The secondary outcome was the incidence of late postoperative complications (urethral fistula, meatal stenosis, wound dehiscence, urethral diverticulum). All patients were followed up for at least 6 months postoperatively.

Results. The following results were obtained. In group 1, UTI was observed in 5 patients (8.2%), compared to 13 patients (21.3%) in group 2. SSI was noted in 2 (3.3%) patients in group 1 and in 6 (9.8%) patients in group 2. When assessing long-term postoperative complications over six or more months, meatal stenosis was observed in 2 (3.3%) patients in group 1 and in 1 (1.6%) patient in group 2. Urethral fistulas developed in 3 (4.9%) patients in group 1 and in 4 (6.6%) patients in group 2. A urethral diverticulum was noted in 1 (1.6%) patient with meatal stenosis in group 1. Wound dehiscence occurred in one boy (1.6%) from group 1 and in 2 (3.3%) patients from group 2. The total complication rate in both groups was 11.5%.

Conclusions. The use of antibiotic prophylaxis reduces the incidence of SSI and UTI in the surgical treatment of distal hypospadias but does not lead to improved long-term outcomes. The benefit of prophylactic antibiotic administration in this context is questionable.

Contribution:
Sukhodolsky A.A. — concept and design of the study;
Sukhodolsky A.A., Fedulov A.V., Sytkov V.V., Yanorova A.I., Anikeeva Yu.A., Mikhailov E.S., Nechay A.V. — collection and processing of the material;
Sukhodolsky A.A., Fedulov A.V. — writing the text;
Sukhodolsky A.A., Zorkin S.N., Poddubny I.V., Sytkov V.V., Chernukha M.Yu. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. This work was supported by the state budget-funded research program of the Moscow Region: “Study of the Efficacy of Perioperative Antibiotic Therapy in the Prevention of Surgical Site Infections in Children with Diseases of the Urinary System”.

Conflict of interest. The authors declare no conflict of interest.

Received: October 30, 2025
Accepted: November 27, 2025
Published: December 25, 2025

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