Objective To evaluate the efficacy of one-stage treatment of severe hypospadias by urethral plate incision island flap coverage, and its impact on aesthetic satisfaction. Methods A total of 84 children with severe hypospadias treated in our hospital from April2022 to April 2024 were selected as the research subjects and divided into the observation group and the control group by random number table, 42 cases in each group. The control group underwent staged urethral plate reconstruction with a rolled tube, while the observation group underwent one-stage treatment bythral plate incision and island flap coverage. The success rate of surgery, clinical surgical indicators, incidence of complications, and aesthetic satisfaction of the children"s families compared between the two groups. Results The success rate of surgery in the observation group (95.24%) was higher than that in the control group (3.33%) (P<0.05). There was no significant difference in the operation time between the observation group and the control group (P0.05), but the time to get out of bed and the hospitalization time were shorter in the observation group than in the control group (P<.05). The incidence of complications in the observation group (4.76%) was lower than that in the control group (11.90%)P<0.05). The satisfaction of the children"s families in the observation group (97.62%) was higher than that in the control (85.71%) (P<0.05). Conclusion One-stage treatment of severe hypospadias by urethral plate inc and island flap coverage can improve the aesthetic satisfaction of the children"s families, shorten the postoperative recovery time, reduce the incidence of complications, and achieve relatively ideal results, which is worth applying in clinical practice.