Background <p>Hypospadias is one of the most common male congenital anomalies and often requires a surgical approach. Several repair techniques have been developed to improve the outcomes, including the autologous platelet-rich treatment (APT). There remains a controversy that whether the application of APT really benefits hypospadias repair.</p> Materials and methods <p>The current study was performed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines and was registered. The systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before May 2025. The primary outcomes included operative time, length of hospital stay, urethral fistula, meatal stenosis, urethral stricture, wound infection, glans dehiscence, bleeding and total complication rates.</p> Results <p>Totally 562 pediatric patients from 7 independent controlled trials including 5 randomized controlled trials (RCTs) were obtained for the final analysis. In the comparison between the APT group and non-APT group, no significant difference was found as regards operation time, hospital stay, glans dehiscence and urethral stricture. However, the APT group may exhibit potential benefits in urethral fistula (OR:0.51, 95%CI: 0.29–0.91, <i>p</i> = 0.02), meatal stenosis (OR:0.35, 95%CI: 0.14–0.90, <i>p</i> = 0.03), wound infection (OR:0.19, 95%CI: 0.07–0.46, <i>p</i> &lt; 0.001) and total complications (OR:0.30, 95%CI: 0.16–0.55, <i>p</i> &lt; 0.001).</p> Conclusions <p>APT was an efficient and safe procedure in the management of hypospadias repair. Compared with non-APT group, the application of APT was associated with decreased postoperative complications including urethral fistula, meatal stenosis and wound infection. More RCTs with larger sample size are still needed.</p>