Is parenteral antibiotic prophylaxis associated with fewer infectious complications in stented, distal hypospadias repair?

INTRODUCTION: Judicious use of antibiotics for surgical prophylaxis is important for reducing antimicrobial resistance while preventing infectious surgical complications. In the setting of pediatric distal hypospadias repairs, it is unclear if antibiotic surgical prophylaxis is beneficial. OBJECTIVE: The purpose of this study was to compare rates of infectious complications in pediatric subjects undergoing distal hypospadias repair who received any peri-operative antibiotics to those who did not. STUDY DESIGN: This was a review of a retrospective cohort from a database of individuals undergoing hypospadias repairs evaluating whether they received peri-operative or post-operative antibiotic prophylaxis and determining the rate of infectious complications in those who did compared to those who did not receive antibiotic prophylaxis. Infectious complications were defined as surgical site infection (SSI) or urinary tract infection (UTI). RESULTS: There was no significant difference in infectious complication rates between individuals who received peri-operative parenteral antibiotic prophylaxis and those who did not. All subjects with infectious complications received post-operative oral antibiotic prophylaxis. There was one instance of C. difficile infection in a subject who received peri-operative parenteral antibiotics. DISCUSSION: Reducing antibiotic utilization without increasing infectious surgical complications is important in safely reducing antimicrobial resistance. In this study of pediatric distal hypospadias repair, peri-operative antibiotics did not demonstrate a clear benefit and post-operative oral antibiotics demonstrated no benefit in preventing infectious complications. Other studies evaluating peri- and post-operative antibiotics for pediatric hypospadias repair have also failed to demonstrate a benefit for antibiotics in preventing infections. Practitioners should reconsider the use of antibiotics in this setting. CONCLUSION: Routine antibiotic prophylaxis does not appear beneficial for preventing infectious complications following uncomplicated, stented pediatric distal hypospadias repairs.

Flat Panel Detector c-Arms Are Associated with Dramatically Reduced Radiation Exposure During Ureteroscopy and Produce Superior Images.

Background: We wished to determine whether newly available flat panel detector (FPD) c-arms were (1) associated with lower radiation dose during ureteroscopy (URS) than conventional image intensifier (CII) c-arms and (2) to compare fluoroscopic image quality between the units. Materials and Methods: We retrospectively reviewed 44 consecutive patients undergoing URS at a pediatric hospital, with c-arms assigned by availability in the operating room. We performed dosimetry experiments using the same c-arms on standard phantoms. Results: Patient and case characteristics did not differ significantly between the two groups of patients. The median dose in the FPD group was less than a quarter of the dose in the CII group, 0.48 [0.42, 0.97] mGy vs 2.2 [1.1, 3.8] mGy, p < 0.0001. The FPD dose remained at less than one-third of the CII dose accounting for any difference in fluoroscopy time, and remained significant in a multivariate model including fluoroscopy time and patient weight (ß = 2.4, p = 0.007). Phantom studies showed higher image quality for FPDs at all simulated patient sizes, even at lower radiation doses. Conclusions: This is the first report comparing radiation dose from c-arms of image intensifiers and FPDs in adults or children. Use of an FPD during URS was associated with a substantially decreased absorbed dose for patients while simultaneously improving image quality.