A Useful Tip for Preventing Surgical Site Infections after Hypospadias Repair. A Single Surgeon's Experience of 376 Cases

Abstract

Purpose: We report the efficacy of pre- and post-operative showering for preventing surgical site infections (SSIs) and urethrocutaneous fistula after hypospadias surgery. Materials and Methods: In 2006, standardised pre- and postoperative showering was introduced for hypospadias patients. Showering involves washing the genitals and groin 2 h preoperatively as well as immediately after the removal of a stent postoperatively. Data from 520 procedures performed on 376 hypospadias patients by a single surgeon from 1996 to 2015 were collected prospectively. The shower (S) group comprised 258 patients (372 procedures) and the nonshower group comprised 118 patients (148 procedures). Management protocols were identical for two groups. Results: Patient demographics were similar. SSIs were significantly less in the S group (0% vs. 2.0%; P < 0.05). The incidence of fistulas was lower in the S group (2.0% vs. 6.3%). The mean duration of follow-up was significantly shorter in the S group (3.6 vs. 12.8 years; P < 0.05) but longer than the mean time taken for complications to develop (0.4 years). Conclusions: Our results suggest that pre- and post-operative showering may contribute to preventing SSIs and fistulas in hypospadias patients.

Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study

“…During a controlled trial, Roth et al 27 randomised seventy patients with mid-shaft or distal hypospadias who received either trimethoprim-sulfamethoxazole postoperatively or no antibiotic prophylaxis and found that antibiotic prophylaxis significantly decreased the incidence of asymptomatic bacteriuria but had no role in the prevention of other postoperative complications. Murakami et al 28 assessed the role of preoperative and postoperative showering in the prevention of complications for 376 patients who underwent hypospadias repair by the same surgeon and found significantly fewer surgical site infections on the showering arm (P=0.023) and a low overall complication rate (P=0.0019); however, no significant difference in the urethral fistula rate was observed (P=0.081). They recommended that patients should shower two hours preoperatively, immediately after urethral stent removal, and after defecation to reduce the risk of complications after hypospadias repair.…”