br Results A total of

Results A total of 126 respondents completed the survey (68.5% response rate), with at least 65% response rate from each of the four represented sectors (denominators represent the total constituent body of the organization or the total attendees of the meeting): PUC 24 out of 37 (65%), SPUNZA 33 out of 37 (89%), AAPU 23 out of 27 (85%), and BAPU 46 out of 70 (66%). All 126 respondents had completed all questions on the survey. Individual responses pertaining to scenarios are available in the Table 1. The overall rates of antibiotic prescription of PU around the world are available in Fig. 1.
Discussion Glaser et al. [7] explored the topic of variability amongst North American PUs who are part of Society of Pediatric Urology (SPU) and found that there was a significant variation in antibiotic use amongst North American PUs for short-term catheterizations. However, the results of their study is similar to what was found in this investigation: the majority of SPU members would prescribe prophylactic 28170 less than 20% of the time for Foley catheter, suprapubic tube, and J-J stents while the majority of SPU members would prescribe prophylactic antibiotics with a hypospadias stent. Although not directly comparable to this study due to Glaser et al.’s focus on specific antibiotic regimen and options for participants to choose between ranges of preference (prescribing antibiotics 0–100% of the time for a given scenario), the findings of Glaser et al. and this study can be used in conjunction to illustrate that there may not only be an inter-regional but also an intra-regional variability that reflects the lack of consensus on this topic [7]. In exploring the current literature and guidelines behind the survey scenarios, the AUA and CDC alike do not recommend prophylactic antibiotics beyond 24 h postoperatively and after the surgical incision is closed, respectively [5], [8]. These statements are consistent with a review that has shown that there is no role of prophylactic antibiotic use in long-term catheterizations [9]. As North American based practitioners, expectedly, AAPU PUs and PUC members were more likely to adhere to these practice guidelines and did not favor administration of long-term antibiotics for indwelling urethral and suprapubic catheters. In comparison, the overwhelming majority of SPUNZA members and BAPU PU were using antibiotics either therapeutically or prophylactically. This highlights an important difference within the Pediatric Urology community and warrants further investigation with regards to balancing benefit and risk of antibiotic use, especially with the rise of antibiotic resistant organisms and superinfections that contribute to negative outcome and increased costs [2], [3], [4]. The AUA recommends that all procedures involving cystourethroscopy with manipulation, including stent placement, to receive antibiotic prophylaxis to reduce the potential for infection [5]. However, the evidence behind use of antibiotics prior to stent insertion is limited and indirect, with one trial involving pre-procedural prophylactic antibiotic before stent insertion [10]. Moreover, data on use of antibiotics while the stent is indwelling in a patient is scarce with one institutional data showing that extended prophylactic antibiotics showed no significant impact on the rate of urinary tract infections (UTIs) in children undergoing minimally invasive pyeloplasty with ureteral stents [11]. Our results were reflective of the lack of consensus on this topic—most PUC members, approximately half of AAPU PU and less than a fifth of the BAPU PUs and SPUNZA members preferred to withhold antibiotics. There is also limited evidence regarding the use of perioperative antibiotics for hypospadias repair. While historical data suggests an increased rate of UTIs and complications without prophylactic antibiotics [12], more recent studies show that pre- or postoperative antibiotic use does not decrease the incidence of UTIs or complications [13], [14]. Again, our results were heterogeneous between sectors for the clinical scenarios associated with hypospadias. Understanding that hypospadias technique and routine is surgeon dependent, studies are ongoing to help clarify antibiotic use in this operation. With this prospective data, we can develop guidelines for surgeons to follow internationally.