Do Perioperative Antibiotics Improve Outcomes After Hypospadias Repair? A Systematic Review and Meta-Analysis of Pediatric Literature

<b>Background/Objectives</b>: The role, timing, and duration of antibiotic therapy in hypospadias repair remain controversial, with substantial variability in clinical practice and a lack of evidence-based guidelines. This systematic review and meta-analysis aimed to evaluate whether preoperative, postoperative, or combined perioperative antibiotic regimens influence postoperative outcomes after hypospadias repair. <b>Methods</b>: A systematic literature search of PubMed, MEDLINE, Scopus, Embase, and Web of Science was conducted in accordance with PRISMA guidelines to identify studies published between 2000 and 2025 that reported on perioperative antibiotic administration in pediatric patients undergoing hypospadias surgery. Three comparisons were assessed: (i) postoperative antibiotics versus no antibiotics, (ii) preoperative antibiotics versus no antibiotics, and (iii) combined pre- and postoperative antibiotics versus no antibiotics. Outcomes included infectious complications, wound dehiscence, urethrocutaneous fistula, meatal or urethral stenosis, and other postoperative complications. Random-effects meta-analyses were performed, with pooled odds ratios reported together with 95% confidence intervals. <b>Results</b>: Ten studies comprising a total of 9493 patients were included. Perioperative antibiotic use was not associated with a significant reduction in infectious complications (OR 0.95, 95% CI 0.63-1.44; <i>p</i> = 0.81), urethrocutaneous fistula (OR 1.89, 95% CI 0.87-4.12; <i>p</i> = 0.10), or wound dehiscence (OR 1.52, 95% CI 0.98-2.35; <i>p</i> = 0.06) compared with no antibiotic use. Preoperative antibiotic prophylaxis alone did not result in a reduction in infectious complications or wound dehiscence. Combined pre- and postoperative antibiotic therapy did not demonstrate a clear benefit over no antibiotics in terms of infectious complications, although available data were very limited. <b>Conclusions</b>: Routine perioperative antibiotic therapy does not significantly reduce postoperative complications after hypospadias repair. These findings support a selective, risk-based approach to antibiotic use rather than routine administration in hypospadias surgery. Further well-designed prospective studies are needed to establish evidence-based perioperative antibiotic protocols in pediatric hypospadias surgery.