A meta-analysis compared postoperative prophylactic antibiotics with no use in pediatric hypospadias repair. It included seven studies (five RCTs and two NRCTs) with 862 children, of whom 462 received antibiotics and 400 did not. In the group with antibiotics, 53 children had complications, in the group without them 31 children. Antibiotics significantly reduced the incidence of urinary tract infections (UTI, p=0.004). However, there were no differences in overall complications (p=0.61), fistula (p=0.96), meatal stenosis (p=0.40 or 0.55), SSI (p=0.47), dehiscence (p=0.27), or diverticulum (p=0.98). The reduction in UTIs may mainly reflect asymptomatic bacteriuria rather than symptomatic infections. The routine use of antibiotics is recommended to be reconsidered in favor of individualized risk approaches.