Over the past 12 years, technological advancements in the field of endourologic surgery have resulted in shifting clinical practice for endourologists, with trends favoring smaller, actively flexible ureteroscopes, intrarenal surgery, and nitinol basket use.

In cases where little local tissue is present the SOS flap procedure is an excellent way to transfer healthy dorsal tissue to the ventrum for an onlay salvage urethroplasty while providing additional coverage of the urethral defect and a tension-free skin closure. Despite the high fistula rate we encountered following the initial SOS procedure, we endorse this technique because the transferred dartos provides additional tissue, which facilitates subsequent fistula repair. These boys can achieve a successful cosmetic result without incorporation of scrotal tissue or a free graft, which we believe leads to more predictable results.

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