Hypospadias repair: Onlay island flap

(A) Proximal hypospadias with the abnormal urethral meatus at the penile scrotal junction. A strip of tissue, "the urethral plate," is outlined on the ventral aspect of the penile shaft, which will ultimately be the roof of the new urethra. The circumferential incision around the distal end of the penile shaft is placed in the normal position where a circumcision is performed.
(B) The urethral plate has been preserved and the penile skin dissected off the corporal bodies (this typically straightens the penis if there was any inherent curvature). The inner prepuce of the dorsal hooded foreskin has been outlined in preparation for creating a vascularized flap that will be patched onto the urethral plate.
(C) The vascularized inner prepuce is sewn to both sides of the urethral plate to create the new urethra. After completion of the new urethra the glans will be reconstructed and the extra dorsal penile shaft skin used to cover the penis and complete the repair.