Hypospadias surgery is continually evolving, which means that no technique is considered perfect and applicable in all cases without complications. (70 – 73) The use of interposition flaps is well documented in the literature. Those taken from the foreskin are triangular soft tissue flaps (74) and Belman flaps. (75) The penile skin-based flap is the Smith D flap (70), while the Buck fascial flap is harvested from the shaft of the penis. The corpus spongiosum from either the normal native urethra as a renewal perimeatal flap or from the spongiosa divergenta was also used. A scrotal dartos flap from the scrotum (76,77) or a TVF (78) from the testis can also be used. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay Snodgrass (79) described additional coverage of the neurethra by vascularized subcutaneous tissue dissected from the skin of the dorsal prepucial and shaft. This dissection requires skill and it is possible that the vascularity of the skin may be compromised, leading to subsequent skin necrosis. Duckett (80) attributed it to hypovascularization of the overlying skin when the dartos is separated from the skin. Although there are different options for covering soft tissue, the ideal solution has still not been found. Dartos-based flaps have the advantage of being locally available and do not require another incision or extension of the incision. Snow et al. (81), in 1995, were the first to report the use of the tunica vaginalis as an interposition graft. The reported fistula rate was 9%. Similar results were also reported by Shankar et al. (82) and Handoo.(83) It is a reliable soft tissue cover for revision cases and posterior hypospadias surgery.(84) In his recent experience, Snodgrass was able to reduce the rate of 0% fistula with the use of TVF.(85) In our study, four cases in group A developed urethrocutaneous fistula. two of which were associated with meatal stenosis, leading to fistula formation. One of them presents with wound dehiscence and marginal necrosis that exposes the neurethra and causes fistula formation. Use of Dartos may result in skin loss or skin necrosis due to damage to the intrinsic blood supply to the outer skin. As TVF is not skin dependent, ventral skin coverage is compromised in fewer cases. Seven fistulas occurred in group B but five were cured by conservative means, two required reoperation for closure. In two of these this was possibly related to the development of meatal stenosis, in one case leading to a large fistula and in one case wound dehiscence had occurred leading to the formation of a large fistula. The difference in fistula rates in the two groups is not statistically significant, probably due to the small sample size. Chatterjee et al. (86) prospectively compared the two neourethral coverage techniques after a TIP procedure. They concluded that TIP with TVF could be an alternative to other techniques in a primary case of hypospadias. However, this was a multi-institutional study inviting surgeon variation. In their study, the fistula rate for TVF and dartos flap cases was 0% and 15-20%, respectively. Dhua et al (87) reported in 2012 that the fistula formation rate was 0% with TVF waterproofing and the fistula rate for the dartos flap was 12%..