Our experience with hypospadias surgery has changed over the recent five-year period. We are using less preputial tubularized island flaps for urethral replacement and more onlay island flap procedures. Approximately, 20% of hypospadias occurs from the penoscrotal junction to the perineum, while 30% occur in the mid portion of the penis. Fifty percent are distal penile or subcoronal (Figure1). There are different operative procedures to repair these varying types of hypospadias.