Single-Center Experience with a Bridging Antibiotic Strategy Following Pediatric Distal Hypospadias Repair.: 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, antibiotic prophylaxis, pediatric urology, antimicrobial stewardship.

Abstract

Background: The optimal duration of antibiotic prophylaxis following pediatric urethroplasty remains controversial. While recent evidence suggests limited benefit from prolonged postoperative antibiotics, many surgeons continue their routine use because of concerns regarding urinary tract infections (UTIs) and surgical complications. This study evaluated the outcomes of a bridging antibiotic strategy consisting of a single perioperative antibiotic dose followed by a short postoperative oral course in children undergoing primary distal hypospadias repair.

Methodology: This retrospective single-center observational cohort study was conducted at a tertiary pediatric urology center in Dubai, United Arab Emirates. Medical records of 239 consecutive children who underwent primary distal hypospadias repair between July 2021 and July 2025 were reviewed. All patients received a single perioperative intravenous dose of a second-generation cephalosporin followed by a short postoperative oral antibiotic course until urethral stent removal. Postoperative infectious and structural complications were assessed during routine follow-up.

Results: A total of 239 children underwent primary distal hypospadias repair, with a mean age of 22.5 ± 5.1 months. Postoperative infectious morbidity was low, with only three cases of culture-confirmed urinary tract infection (1.3%), all successfully managed with oral antibiotics. No wound infections, soft tissue infections, stent-related infectious complications, or febrile episodes were observed. Structural complications were uncommon, with urethrocutaneous fistula occurring in five patients (2.0%). No cases of meatal stenosis, wound dehiscence, or diverticulum were identified during follow-up.

Conclusion: A bridging antibiotic regimen consisting of a single perioperative antibiotic dose followed by brief postoperative chemoprophylaxis was associated with low rates of infectious and structural complications after primary distal hypospadias repair. This approach may represent a practical strategy for reducing antibiotic exposure while maintaining favorable surgical outcomes and supporting antimicrobial stewardship principles.