Single-Center Experience with Postoperative Chemoprophylaxis in Pediatric Urethroplasty: Bridging Single-Dose Perioperative and Regular Postoperative Antibiotic Regimens: Original Article

Vipul gupta; Wisam Salih Saad; Ghadir Jaber; Diary A  Mohammad; Mamoun Almarzouqi

doi:10.69885/pju.v4i1.126

Authors

Vipul gupta Clinical associate professor MBRU https://orcid.org/0009-0001-5423-9776
Wisam Salih Saad Clinical Attaché, Pediatric Surgery Department of Pediatric Surgery and Pediatric Urology Al Jalila Children Hospital, Dubai https://orcid.org/0000-0001-6398-202X
Ghadir Jaber Consultant Pediatric Surgeon Department of Pediatric Surgery and Pediatric Urology AL Jalila Children Hospital, Dubai https://orcid.org/0009-0003-9919-0325
Diary A Mohammad Consultant Pediatric Surgeon Department of Pediatric Surgery and Pediatric Urology AL Jalila Children Hospital, Dubai https://orcid.org/0000-0002-6671-9814
Mamoun Almarzouqi Consultant Pediatric Surgeon Department of Pediatric Surgery and Pediatric Urology AL Jalila Children Hospital, Dubai https://orcid.org/0009-0003-6568-0270

DOI:

https://doi.org/10.69885/pju.v4i1.126

Keywords:

Distal Hypospadias, urethroplasty

Abstract

Background

Optimal antibiotic prophylaxis in pediatric urethroplasty remains controversial, with significant variation in practice among surgeons. Despite emerging evidence showing no significant reduction in postoperative infection or UTI, many surgeons continue routine postoperative antibiotic use. Sudden discontinuation of postoperative antibiotics can be challenging in clinical practice; therefore, the current study's bridging strategy offers a practical transition toward rational antibiotic minimization while maintaining surgeon confidence, reducing cost, and limiting antimicrobial resistance.

Methods

A retrospective review of 239 consecutive primary distal hypospadias repairs performed at a tertiary pediatric surgical center from July 2021 to July 2025 was carried out. All patients received a single perioperative intravenous dose of a second-generation cephalosporin followed by a short oral postoperative antibiotic course continued up until the time of urethral stent removal. The outcome was assessed in terms of urinary tract and soft tissue infection on regular 1 year post-operative follow up.

Results

Among the 239 children reviewed, postoperative infectious morbidity remained low, with only 3 cases of symptomatic, culture-confirmed urinary tract infection (1.3%), all resolving with oral therapy and none requiring admission. No wound or soft-tissue infections, stent-related infectious concerns, or febrile postoperative episodes were observed. Urethrocutaneous fistula developed in 5 children (2.0%), none preceded by UTI or local infection, and no additional complications such as meatal stenosis or infection-related dehiscence were identified, indicating stable outcomes without evidence of increased infection-related morbidity.

Conclusion

A bridging regimen composed of a single perioperative antibiotic dose followed by brief postoperative chemoprophylaxis minimizes infectious complications without increasing structural morbidity. This strategy supports safe reduction of antibiotic exposure and may facilitate a practical transition toward evidence-based antibiotic stewardship in pediatric reconstructive urology.