During a 3 1/2-year period 206 consecutive patients underwent primary hypospadias repair. Of the patients 117 were 6 to 18 months old, 65 were 18 months to 5 years old and 24 were older than 6 years. In 175 patients a single stage reconstruction was performed using a vascularized skin flap for the neourethra. A modified 2-layer closure with optical magnification was performed, and a urethrocutaneous fistula developed in only 1 patient, who had undergone a single stage repair of perineal hypospadias. With the use of contemporary single stage hypospadias reconstructive techniques and a 2-layer closure of the neourethra, urethrocutaneous fistula can virtually be eliminated.