Our modification of onlay island flap urethroplasty in severe hypospadias.

A variant of the only island flap urethroplasty in severe hypospadias repair is described. The principles of technique are: mobilizing of urethral plate, without dividing it, in order to release chordee; creation of pedicle island flap on the dorsal penile skin, with redundant vascularized tissue, which is transposed to the ventral side of penis by buttonhole maneuver; the flap is onlayed to the mobilized urethral plate, while all suture lines are covered with a very wide pedicle of flap, which is decisive for the successful outcome of the operation. During the last 3.5 years (1990-June 1993) the technique was applied in 124 cases of severe hypospadias, aged 12 months to 19 years, with lower complication rate (stricture, fistulas, diverticulum) in comparison to island flap tubularizing urethroplasty (5-15% of patients).