The de-epithelialized flap and its influence on hypospadias repair.

Since its introduction in the 1970s the addition of a complete covering layer over the newly constructed urethra has positively influenced the outcome of hypospadias repairs. Originally applied by Smith during the second stage of a planned 2-stage repair and then to fistula repairs, the de-epithelialized flap has contributed to a marked reduction in post-hypospadias repair complications. The influence of this contribution as well as its application to a variation of the pedicle onlay hypospadias repair is reviewed.