Hypospadias/Penis Is There a Role for Prophylactic Antibiotics after Stented Hypospadias Repair? Niki Kanaroglou, Elias Wehbi, Abdulhakim Alotay, Darius J. Bagli, Martin A. Koyle, Armando J. Lorenzo and Walid A. Farhat* From the Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Purpose: Data are lacking on prophylactic oral antibiotic use in stented hypo- spadias repair cases. We evaluated the role of prophylactic oral antibiotics for preventing symptomatic urinary tract infections in this population. Materials and Methods: We reviewed consecutive patients treated with stented primary/redo hypospadias repair by a single surgeon from September 2009 to January 2012. All patients received antibiotics upon induction. Before April 1, 2011, patients also received prophylactic oral antibiotics while stented. They were compared to those who underwent surgery after April 1, who received no prophylactic oral antibiotics. The primary outcome was symptomatic urinary tract infections, as captured from patient records and verified by an electronic cross-check of ICD-10 codes. Secondary outcomes included cellulitis, fistula, dehiscence and meatal stenosis. Results: Of the 161 patients reviewed 11 were unstented and 1 underwent followup elsewhere. Of the remaining 149 patients 78 received prophylactic oral antibiotics and 71 did not. The groups were well matched for age, hypospadias characteristics, surgical technique and stent duration. Median followup was 17 months (range 0.2 to 33). No culture proven, symptomatic urinary tract infections developed in either group. One patient in the prophylactic group was treated for cellulitis by the pediatrician. The complication rate, including redo cases, was 18.2% in the pro- phylactic group and 15.3% in the nonprophylactic group (p ¼ 0.8). Conclusions: When postoperative prophylactic oral antibiotics were not admin- istered, we identified no increased incidence of symptomatic urinary tract in- fections or complications. Our data suggest that prophylactic oral antibiotics may not be needed in cases of stented hypospadias repair. This study contributes to the growing body of evidence supporting the rational use of antimicrobials. It can potentially serve as a basis for a prospective, multicenter, randomized study. Key Words: urethra, hypospadias, urinary tract infections, antibiotic prophylaxis, stents HYPOSPADIAS occurs in approximately 1/300 live male births. 1 Accordingly, surgical reconstruction for this mal- formation is one of the most common procedures performed by pediatric urologists. While some have described stentless repairs, 2,3 most surgeons place a catheter for urinary drainage in the early postoperative period. Previous studies advocate POA for the duration of stenting. 4,5 However, to our knowledge the value of this Abbreviations and Acronyms POA ¼ prophylactic oral antibiotics TIP ¼ tubularized incised plate TMP ¼ trimethoprim UTI ¼ urinary tract infection Accepted for publication February 7, 2013. Study received ethics board approval. * Correspondence: M299, Black Wing, Sick- kids Hospital, Toronto, Ontario, M5G 1X8, Canada (e-mail: Walid.farhat@sickkids.ca ). 0022-5347/13/1904-1535/0 THE JOURNAL OF UROLOGY ® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. http://dx.doi.org/10.1016/j.juro.2013.02.015 Vol. 190, 1535-1539, October 2013 Printed in U.S.A. www.jurology.com j 1535