Onlay-tube-onlay urethroplasty technique in primary perineal hypospadias surgery

We extended the principles of the onlay flap to the most severe hypospadias cases. Four patients with perineal hypospadias required central division of the urethral plate to correct chordee despite dorsal plication. The urethra was reconstructed in 1 stage by proximally and distally onlaying to the remaining urethral plate a flap with its central portion tubularized to fill the gap where there was no longer a urethral plate. All patients have good cosmetic and functional results at 1 year of followup. There were no strictures or diverticula but 1 fistula developed. This technique extends the principles and advantages of an onlay flap to those severe hypospadias cases that require division of the urethral plate to correct chordee.