Recently, Tong Tong (a pseudonym), who lives in Zhengzhou, came to our urology department for a review accompanied by his family. After a detailed examination, the doctor said that Tong Tong had recovered very well after surgery and was basically the same as a normal child. It turns out that Tong Tong had a congenital hypospadias, which was unsuccessfully treated by several surgeries in many hospitals. When urinating, urine was not only discharged from the urethra, but also ejected in different directions from two parts of the middle of the urethra. This problem makes Tong Tong’s family very distressed, the child can not go to kindergarten, can not go out of town, and wear cotton pants in the winter when it is cold, it is not convenient. At the end of 2013, Tong’s parents came to our urology department with a ray of hope, and found Director Zhang Lihua, who is very knowledgeable about hypospadias. After careful examination, Director Zhang found that the child’s urethral leakage holes were in the body of the penis, and there were two of them. Due to multiple surgeries, the leaky holes were surrounded by scar tissue, there was limited skin available, and the skin had poor blood flow. The chances of success in resolving the urethral fistula would be very low if a traditional urethral fistula repair was used. After careful study, Director Zhang decided to complete this complex urethral fistula repair using a unilateral de-epithelialized double flap approach. On December 17, 2013, Dr. Zhang Lihua, chief surgeon, performed the surgery on Tong. During the surgery, Dr. Zhang first removed the skin bridge between the two adjacent fistulas to make the two fistulas into one fistula, made a circular incision 2 mm from the fistula and extended it 3 mm up and down, and free a rectangular flap on each side with the incision as the midline. The free surface was deep in the fascia to obtain a thicker flap. The flap is approximately 5 mm wide, and the fistula is removed and closed with continuous sutures. Saline is injected into the rectangular flap on the side with thicker subcutaneous tissue (to facilitate removal of the epithelium), the epithelium of the flap is removed to preserve the fascia, and the free fascia is pulled to the opposite side of the fistula to cover the fistula and sutured to the tissue around the fistula. The other side of the flap was pushed to the opposite side, overlapped over the other side of the fascia, and sutured to the wound edge of the removed epithelium, and the wound was dressed with pressure. When the urinary catheter was removed 14 days after surgery, the child was able to urinate successfully and the fistula was healing well, proving once again that the surgery was very successful. According to Director Zhang, urethral fistula is the most frequent comorbidity after urethroplasty, with an incidence of 10.0% to 25.0%. The main reason is poor blood supply to the material where urethroplasty is done, local tissue ischemia, necrosis and infection. It may also be due to urethral stricture and poor urine drainage increasing the tension of the incision, causing the formed urethra to split and forming a urinary fistula. Most urinary fistulas are detected in the first urination after removal of the urethra after surgery, but some small fistulas are detected late or secondary to urethral strictures. Zhang reminds that the timing of repairing a fistula should be more than 6 months after surgery, after the local skin scar has softened and the blood supply has been reestablished, and that small fistulas have the potential to heal on their own. In addition to the traditional repair method, the unilateral removal of the epithelium and double flap method is characterized by the removal of the epithelium on one flap to obtain a wider and thicker fascial layer to cover the fistula, which completely separates the inner and outer suture openings of the fistula, while the outer penile skin overlaps again to cover the fascial layer, and the three suture openings are not in the same section, maximizing the staggered separation and preventing one layer of infection from affecting the other layer of suture splitting. In addition, the two flaps taken have a wide base and good blood flow, so that ischemia and necrosis will not occur, which is conducive to wound healing and greatly improves the success rate of urofistula surgery.