The results in 84 hypospadias repairs using a de-epithelialized skin flap are reported. A variety of 1-stage repairs were applied including those of King, Mathieu, Mustardé and Duckett, and a combined midline and transverse island flap for perineal hypospadias. In each repair a flap of transposed prepuce was swung ventral, de-epithelialized and applied over the urethroplasty. In all but 2 repairs complete coverage of the urethra was achieved by this technique. Reoperation was required in 7 patients (8 per cent) but in only 3 (3.5 per cent) ws this to close a urethrocutaneous fistula. The addition of a de-epithelialized flap to create a layer completely covering the neourethra appears to reduce the incidence of fistulas significantly.