Hypospadias is an important challenge with numerous techniques of repair but none of them standardized [12]. Most seen type of hypospadias is distal type with %50–70 of all hypospadias cases [13]. Anatomical position of urethral meatus moves more proximally the surgery becomes more complicated and less protected from complications. MAGPI and Snodgrass techniques are reliable and mostly accepted by surgeons as distal hypospadias repair [12].

As a reconstructive surgery hypospadias repair is complicated and fistula formation, urethral stricture and diverticula formation are main complications of this surgery. Fistula formation is most important complication with rates of 5–23% in all techniques [11]. Need of new techniques to solve complication problem is still important behind numerous of techniques defined in the literature.

Kutlay defined new technique with 10 patients; none of them had fistula in 13,4 mean follow up time. They defined most important advantage of this new from flip-flap technique no pedicle pressure, and the risk of fistula decreased because no circulatory problem could occur. Also the other advantages are no suture superimposition because of new urethra is covered by skin and glans and no usage of foreskin that some of parents wish to preserve the foreskin [10]. Chordee is most common pathology seen in hypospadias patients. It is an important problem because the need of sufficient urethral plate is important for correction of hypospadias [11]. Snodgrass dorsally plicate the penis to correct curvature in mild chordee patients [6]. Matheiu’s technique is recommended if urethral plate is insufficient for Snodgrass technique [11]. Kutlay technique regardless the urethral plate is sufficient chordee and penile shaft can be exposed and excised easily [10].

New study form Kocak et al. has found one fistula of thirty-one distal hypospadias patients with mean 9,3 months follow up time [14]. Both studies don’t compare Kutlay technique with other hypospadias techniques. In our study we compare Kutlay technique with Snodgrass and no statistical difference found in complication of fistulas rates. In our study, we observed a statistically lower incidence of urethral stricture complications in the Kutlay technique. While the original description of the technique did not report any cases of fistula complications, our study identified two cases of fistula formation in the Kutlay technique. In both groups our fistula rate is nearly one for twenty patients which is lower from the rates defined in literature [15, 16]. The caseload in hypospadias repair is pivotal, and a recent report showed the severe consequences of bad management. A surgical repair that is not performed meticulously and surgical techniques performed without sufficient experience can be a lifelong nightmare for the patient [17]. After Snodgrass popularized the TIP technique, although other surgical techniques are less preferred, alternative methods that young surgeons can prefer in mild variations of hypospadias have also been presented in the literature comparatively with TIP [18].

Although the most distressing complications after hypospadias surgery may appear to be urethral fistula and glans dehiscence, it is actually well known that the most commonly occurring complication is urethral stricture. Bagasi et al. conducted a study involving 408 adult patients who had undergone primary hypospadias repair, where the localization of strictures following surgery was examined. Balanic strictures were manageable with short-term dilation programs, whereas surgical correction may be necessary for bulbar strictures. In our study, we observed urethral stricture more frequently than fistula. Due to the distal nature of the hypospadias surgeries, patients were able to regain normal voiding with a short dilation program [19]. Certainly, dealing with complications such as urethral strictures and fistulas is not always straightforward. Urethral dilation and primary repairs may lead to unsuccessful outcomes in some patients. Recent developments in tissue engineering emphasize the need to consider alternative treatment approaches for individuals with strictures and fistulas. A study that compiles data from six investigations demonstrates that there is promising potential in using tissue engineering, specifically employing epithelial oral or bladder mucosa, to address the complications associated with hypospadias [20].

The most important accepted fact in hypospadias repair is that surgical repair of all patients is not possible with a single method. The method is chosen according to the localization of the meatus and the presence of additional anomalies. The surgeon should be interested in hypospadias surgery by mastering many techniques. Learning and practicing new techniques broadens the surgeon’s vision of repair options. The Kutlay technique seems to be a very suitable method to avoid the fistula complication of hypospadias, but it may be preferred for patients with a well-developed glans, a normal meatus width and adequate penile development.

In conclusion our study is the first study that compares Kutlay technique for hypospadias repair with Snodgrass techniques. The results of our study shows no difference of fistulas complication rates beyond the Kutlay technique group has more complicated cases. In both groups one of twenty patient had fistula formation. As a new technique with well vascularized flap, comparison of Kutlay technique with other hypospadias repair techniques. More randomized prospective studies are needed for Kutlay technique.

The Kutlay technique, a novel approach for distal hypospadias repair, offers potential advantages over the TIP technique, including the creation of a wider urethra due to the use of two flaps for urethral tubularization. This wider urethroplasty is significant as it likely results in fewer complications related to stenosis in both mid-term and long-term follow-ups. Emphasizing these benefits could enhance the consideration of the Kutlay technique as a viable option for young surgeons.

Since the study was conducted in a remote region of Turkey, some hypospadias cases were diagnosed at a later age. Since the correction operation was performed at a later age, the average age was higher than the literature. In order to have more data for our study, patients treated by different clinics and surgeons were included. The small number of patients is a limitation of the study.