Purpose To review our experience with penoscrotal hypospadias (PSH), comparing the results of TIP vs. transverse island flap ONLAY urethroplasties. Material and methods A retrospective review of consecutive patients with PSH was performed. 1657 boys underwent hypospadias repair at our institution from 1998 to 2006. 75 comprised our study population: 35 children underwent a TIP repair, and 40 had an ONLAY procedure. Degree of chordee, type of chordee repair, complications, available uroflowmetry in toliet trained-pts., and number of re-operations were compared between the 2 groups. Results Tabled 1 Variables TIP n=35 (%) ONLAY n=40 (%) p Preop severe chordee (> 45o) 7 (20) 18 (45) 0.02 Dorsal plication 19 (54.3) 27 (67.5) Mean catheter duration (days) 8.5 (7-10) 10.3 (7-14) Overall complication 21 (60) 18 (45) NS Fistula/Breakdown 18 (51.4) 10 (25) 0.01 Fistula location (proximal) 13/18 (72.2) 2/10 (20) 0.02 Recurrent chordee 2 (5.7) 5 (12.5) Average flow rate 3.1 to 13.2 3.0 to 16.0 Flattened shape curve 16/24 (66.6) 7/21 (33.3) <0.01 PVR >30% expected blad capac 2/24 (8.3) 0/21 (0) # pts with >2 re-operations 2 (5.7) 7 (17.5) Open table in a new tab Conclusions The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus, behaves as a relatively “distal resistance” prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches. To review our experience with penoscrotal hypospadias (PSH), comparing the results of TIP vs. transverse island flap ONLAY urethroplasties. A retrospective review of consecutive patients with PSH was performed. 1657 boys underwent hypospadias repair at our institution from 1998 to 2006. 75 comprised our study population: 35 children underwent a TIP repair, and 40 had an ONLAY procedure. Degree of chordee, type of chordee repair, complications, available uroflowmetry in toliet trained-pts., and number of re-operations were compared between the 2 groups. The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus, behaves as a relatively “distal resistance” prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches.