Background and Objectives: The optimal postoperative urinary diversion strategy after hypospadias repair remains debated, with variability in type, material, and duration. Pediatric-specific data are limited. This systematic review and meta-analysis aimed to evaluate how urinary diversion type and duration affected surgical outcomes after pediatric hypospadias repair. Materials and Methods: A systematic search of PubMed, Embase and Cochrane Library (1995–2025) databases was conducted using PRISMA guidelines and registered in PROSPERO (CRD420251121638). Eligible studies included pediatric patients undergoing hypospadias repair with or without urinary diversion. Primary endpoints were diversion characteristics (type, material, duration); secondary endpoints included postoperative complications and re-operations. Results: A total of 31 studies representing 4261 pediatric patients were analyzed, with 16 included in meta-analysis. Pooled estimates confirmed that bladder catheters were associated with significantly higher rates of general complications (wound/urinary tract infections, swelling, foreskin dehiscence) [p < 0.05] and re-operations [p < 0.05] compared to urethral stents. Conversely, urethral stents showed a greater risk of mechanical complications such as blockage and dislodgement [p = 0.001]. Meta-analysis of stented versus unstented procedures revealed no significant differences in major outcomes (fistula, stenosis, re-operations), although stented repairs showed a modest increase in minor complications. For catheterization length, pooled data suggested no significant advantage of prolonged (>5 days) versus shorter (≤5 days) diversion, despite descriptive analyses indicating more functional and general complications [p < 0.05] and re-operations [p = 0.004] after short diversion and more fistulas after prolonged diversion [p < 0.05]. Conclusions: Urinary diversion strategies significantly affected surgical outcomes after pediatric hypospadias repair. Urethral stents reduced general complications compared with bladder catheters but were prone to mechanical issues. Short diversion increased early complications, while prolonged catheterization increased fistula risk. No single approach proved universally superior; therefore, perioperative management should be individualized according to patient characteristics, hypospadias severity, and intraoperative findings. Further high-quality prospective trials are needed to define optimal diversion protocols.

Many ozone-based products that promote the healing process of wounds have been released in recent years. In this study, we evaluate a new spray dressing preparation based on stable ozonides with Vitamin E Acetate in children operated for distal hypospadias. Methods: We included all patients with distal hypospadias, who underwent Tubularized Incised Plate Urethroplasty (TIPU) over a 12-month period. The patients were randomized in two groups according to the type of medication: ozonide spray with Vitamin E Acetate (G1); hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2–3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60, and 180 postoperative days and thereafter annually. At the end of the treatment, we submitted a satisfaction questionnaire to parents. Results: Eighty-six patients (median age 18 months) were included. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). No adverse skin reactions occurred in either group. Foreskin dehiscence and re-operation rates were lower in G1. Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2. The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001). Group 1 found the spray dressing easy to use, improving patient management and adherence. Conclusions: The new preparation of ozonide-based product adopted promoted faster wound healing compared to conventional dressing. Furthermore, this spray preparation is easy to apply, economical, and simpler to preserve. This is better for parents who do not have to touch the wound to apply the product.