Hypospadias is a common congenital malformation of the male lower urinary tract and external genitalia, in which the urethral orifice appears on the proximal side of the normal urethral opening to the perineal pathway, in most cases accompanied by a downward curvature of the penis. Hypospadias can be a single defect or a phenotypic part of a more complex problem such as hermaphroditism. I. Etiology includes three main causes 1. embryological factors 2. genetic genetic factors 3. endocrine factors II. clinical manifestations The typical hypospadias has three features: ectopic urethral orifice; penile hypospadias, i.e., ventral bending of the penis, mostly mild penile hypospadias; and abnormal distribution of the foreskin. The foreskin on the ventral side of the head of the penis has a V-shaped defect because it fails to fuse in the midline, the foreskin tether is absent, and the foreskin accumulates in a cap-like pattern on the dorsal side of the head of the penis. Clinical typing According to the location of the urethral opening hypospadias is divided into four types: Ⅰ° urethral opening is located in the penile head and coronal groove, accounting for about 50%; Ⅱ°: located in the penile body, accounting for about 20%; Ⅲ°: located in the penile scrotal junction; Ⅳ°: located in the perineum, Ⅲ° and Ⅳ° are severe hypospadias accounting for about 30%. The most common concomitant deformities of hypospadias are inguinal hernia and testicular descent insufficiency, accounting for about 9% each. The more serious the hypospadias, the higher the rate of associated deformities. The prostatic capsule is often associated with severe hypospadias, and the incidence is thought to be as high as 10-15% in perineal and penile scrotal hypospadias. The incidence of prostatic capsules in perineal hypospadias has been reported to be as high as 57%. The prostatic capsule may be a remnant of incomplete degeneration of the Müllerian duct or incomplete masculinization of the urogenital sinus, which opens posterior to the urethra in the prostate. In normal individuals, there is a small depression in the center of the seminal mound called the prostatic capsule. In the case of hypospadias, the prostatic bursa elongates and extends posteriorly toward the bladder, forming a large cystic cavity that may be complicated by infection and stones, and may also interfere with catheter insertion. If complicated by infection, recurrent epididymitis is the most common. There are few symptoms of infection before the surgery, and after urethroplasty, due to the lengthening of the urethra and increased urethral resistance, epididymitis is easily associated. Voiding cystourethrography, urethroscopy, ultrasound and CT can pick up and clarify its location. Prostatic sacs can also occur in people without hypospadias. V. Diagnosis The diagnosis of hypospadias can be known at a glance. When hypospadias, especially severe hypospadias, is combined with cryptorchidism, attention should be paid to identify the presence of gender dysplasia. Treatment Patients with hypospadias and abnormal position of the urethra, inability to urinate standing up, painful erection and inability to have children in adulthood, must be treated surgically. Surgery should be completed before school age, and in recent years most authors advocate surgery after the age of 1 year. There are more than 300 published surgical methods, and there is no one satisfactory procedure that is accepted by all physicians. Regardless of the surgical method, the currently accepted criteria for cure should be achieved: ① complete correction of penile recurvature; ② urethral orifice in the positive position of the penile head; ③ satisfactory penile appearance, even distribution of foreskin without superfluous skin; ④ standing and urinating like normal people, and being able to have normal sexual life in adulthood. In recent years, some authors require that the newly formed urethral orifice should be longitudinally cleft as normal to obtain a better appearance. The treatment of hypospadias consists of two main steps: correction of penile hypospadias and urethroplasty. The correction of hypospadias consists of two basic methods: ① release of the lengthening ventral side, i.e. transection of the urethral plate and release of the fibrous scar tissue on the ventral side of the penis; ② tightening of the dorsal side, i.e. dorsal leukodystrophy. Dorsal white membrane tightening is simple and effective in correcting minor penile hypospadias, and loosening and lengthening the ventral side more than adequately corrects obvious penile hypospadias, and severe penile hypospadias often has shortening in all layers from the skin to the intercavernous white membrane, which may be corrected satisfactorily by using the above two methods in combination. For some severe hypospadias the first phase of surgery to correct the penile hypospadias, the second phase of surgery to form the urethra of the staged surgery is still meaningful, to a certain extent to reduce the difficulty of surgery and reduce postoperative complications, the disadvantage is to increase the number of operations and prolong the treatment time. VII. Postoperative complications The most common postoperative comorbidities of hypospadias include: urethral fistula, urethral stricture, and urethral diverticulum-like dilatation.