Hypospadias is one of the most common congenital malformations of the male genitourinary system, and the purpose of surgery is to reconstruct a functioning urethra, restore a good-looking penis, and obtain normal sexual function and fertility. Hypospadias is unable to discharge semen into the female genital tract due to abnormal urethral opening, severe penile curvature and surgical complications, or abnormal testicular function and decreased semen quality, making it infertile. Early treatment, selection of a reasonable surgical method and improved surgical techniques can correct penile and urethral deformities and reduce the psychosexual impact. Smooth urination and good quality of erection after surgery do not fully represent the ability of testicular sperm production and fertility, because hypospadias is a local manifestation of abnormal gonadal endocrine function of the organism. Abnormal gonadal endocrine function is an important reason for the development of hypospadias during the embryonic period, as well as for the development of hypogonadism and fertility disorders in young genitalia. The literature reports that the incidence of ejaculatory disorders after hypospadias is in the range of 6-37%. Therefore, there should be a concept of “comprehensive treatment” for hypospadias, including rational surgical intervention, assessment of genital development, sexual behavior guidance, fertility assessment and appropriate endocrine therapy, and long-term follow-up is valuable, especially in patients with proximal hypospadias or combined with other urological anomalies.