Comparison of Onlay and Tubularized Island Flaps of Inner Preputial Skin for the Repair of Proximal Hypospadias

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

“…Weiner et al [16] reported diverticulum formation in 12% of the tubularized island flap repairs in their series of 132 patients.…”

Hypospadias repair with onlay preputial graft: a 25‐year experience with long‐term follow‐up

“…However, it is known that one of the risks of tubed grafts or flaps is a higher rate of urethral stricture [2] and onlay grafts and flaps have grown more popular over time. Onlay preputial flaps were popularised by Duckett [3] and have been reported extensively [3][4][5]; however, there are relatively few reports of onlay preputial grafts.…”

Two-stage repair for proximal hypospadias: A reappraisal

“…50%) [13]. Fistula rates as high as 40% have been reported [13][14][15][16][17][18][19][20][21][22]. Some surgeons have reduced the fistula rate by employing two-layer closures and additional layers of overlying tissue [23].…”

“…Up to 7% of complete graft sloughing has been reported [16]. Up to 12% develop diverticuli that require correction [20]. Poor cosmetic outcome, which is characterized by excessive bulkiness, penile torsion, or meatal abnormalities of up to 60%, have been reported [17,21,25].…”

“…In general, onlays have fewer fistulas. However, fistula rates ranging from 7% to 60% have been reported [8,19,20,22,27,28]. Recurrent strictures have occurred in as many as 50% of the patients, and some strictures have required open surgery as opposed to simple cystoscopic incision.…”