Objective To explore the effects of applying microsurgical technique in the one-stage urethroplasty for hypospadias with longitudinal preputial island flaps of dorsum penis. Methods Forty-two hypospadias cases with obvious phallocampsis were reviewed. The patients aged from 1 to 19 years (median, 6.4 years). Among them, 6 cases were of coronary suleus type, 28 cases of pe-nis body type, and 8 cases of penis and scrotum type. All patients went through the operative proce-dures by microscope with four-times magnification and microsurgical instruments. Longitudinal prepu-tial island flaps of dorsum penis was employed for the treatment of 33 cases of these patients, and 9 cases underwent longitudinal preputial island flaps of dorsum penis combined scrotal septal pedicle flaps. Results Thirty-eight cases were cured by one-time surgery (90.5%). One case with urethral fistula after operation was cured by surgical repair of urethral fistula. Two cases with urethral meatus stricture after operation and one with urethral stoma stricture were cured by dilatation. Patients were followed for 9 to 52 months (mean, 27 months). Conclusion Use of microsurgical technique with longitudinal preputial island flaps of dorsum penis in one-stage urethroplasty for hypospadias improved the success rate of surgery with few complications.