A meta-analysis: postoperative prophylactic antibiotics compared with non-antibiotics for pediatric hypospadias repair.

Objective: This study evaluated the impact of postoperative prophylactic antibiotics (PA) use on complications after hypospadias surgery, to guide clinical diagnosis and treatment, as well as promote the rational application of PA. Method: Through computer searches of PubMed, EMbase and Cochrane Library, randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) on the postoperative PA for hypospadias from the year 2000 to the present were included. The included studies divided the subjects into antibiotics and non-antibiotics groups based on whether PA was used postoperatively. Data analysis was performed using RevMan 5.4 and STATA 18.0 software, determining the odds ratio (OR) and 95% confidence interval (CI) through fixed-effect or random-effect models. Results: A total of seven studies were included in the research, comprising five RCT and two NRCT, involving 862 participants. Among these, 462 participants received antibiotics, with 53 experiencing complications. Two hundred and fifty-nine participants did not receive antibiotics, with 31 experiencing complications. The results of the meta-analysis indicated that there was a significant difference in the incidence of urinary tract infections (UTI) between the antibiotics group and the non-antibiotics group ( Conclusion: This meta-analysis demonstrated that postoperative PA significantly reduced the incidence of UTI following pediatric hypospadias repair. However, no significant benefits were observed for OC, fistula, MS, sUTI, SSI, dehiscence, or diverticulum. The clinical relevance of this UTI reduction may be limited as it primarily reflects decreased asymptomatic bacteriuria rather than symptomatic infections. These findings suggest that routine postoperative PA use should be reconsidered, and individualized, risk-stratified approaches are needed.