BackgroundUrethral plate(UP) reserved Onlay urethroplasty currently had been widely used in mid-distal hypospadias. However, for children with 15-30° bending after degloving, only dorsal tunica albuginea plication was performed to correct penile ventral curvature(VC), and long-term follow-up showed a high recurrence rate of penile curvature. We developed a modified Onlay urethroplasty which dissociated the UP and completely removed the tissue beneath UP to fully correct penile curvature, and compared it with the standard Onlay urethroplasty to explore its rationality and feasibility. MethodsWe prospectively collected clinical data from 68 children with hypospadias who underwent standard or modified Onlay urethroplasty between September 2019 and June 2021, and evaluated interim outcomes to identify the complications between two groups. And we conducted histological examination of the tissue beneath the UP. ResultsA total of thirty-two patients underwent modified Onlay urethroplasty. Intraoperative curvature measurements showed that 37.5% (12/32) of patients had completely straightened their penis after dissecting UP and removing fibrous tissue beneath it. A total of thirty-six patients underwent standard Onlay urethroplasty. Totally five fistulas were reported in the first and second groups, respecitively as well as the complication rates were 15.6% and 13.9%, respectively (P > 0.05). The histological results showed that the tissue below the UP contains a large amount of collagen, mainly type I collagen. ConclusionThe dissociated UP Onlay urethroplasty can maximally remove factors limiting penis growth and completely correct penile curvature, without increasing the incidence of postoperative complications.Therefore, we recommend the application of improved Onlay urethroplasty in children with mid-distal hypospadias.