Koyanagi described an elegant technique for one-stage proximal hypospadias repair. It is particularly suited for the most severe forms of hypospadias. A modified Koyanagi technique was used to repair the hypospadias in 14 children, aged 3-9 years. One child developed breakdown of the suture line, three other children developed small urethrocutaneous fistula needing closure and one child had post-operative meatal stenosis. Despite the high rate of complications, modified Koyanagi's procedure is a good procedure of choice for severe/proximal hypospadias.