Hypospadias? —- is the most common congenital malformation of the male genitourinary system, with an incidence of 1 in 300. It is thought to be recessively inherited, and if a couple has a child with hypospadias, there is a 10% chance that other children will be born. Normally, after the seventh week of embryonic life, the urethral folds gradually fuse from the proximal end of the urethra to the glans to form a tube called the urethra, a process that depends on the androgens secreted by the embryonic gonads and on the response of the embryonic urethral grooves and folds to cold ketones. Hypospadias is caused when the formation of a tubular urethral wall is impaired. In addition, the interstitial tissue at the urethral opening does not develop, forming a fan-shaped fibrous cord that surrounds the external urethral opening and extends and embeds in the glans. Therefore, hypospadias has 4 basic anatomic features: 1 abnormal urethral opening; 2 deformity of penile flexion to the ventral side; 3 normal dorsal penile prepuce and lack of ventral prepuce; 4 hypoplasia of the urethral corpus cavernosum, which extends from the penile tether to the abnormal urethral opening, forming a thick fibrous band. Typing Clinically, there are 4 types according to the location of the urethral opening. 1 Penile head type: the urethral opening is in the ventral center of the coronal sulcus. In addition to the narrower urethral opening, this type does not affect the function of urination and sexual intercourse and can be treated without surgery. Foreign countries emphasize cosmetology and advocate surgery to move the external urethral opening forward to a normal position. 2 Penile type: The urethral opening is on the ventral side of the penis and requires surgical correction. Penile-scrotal type: The urethral opening is at the junction of the scrotum and penis, and the penis is severely curved. 3 Scrotal type: The external urethral opening is located in the scrotum, in addition to the general characteristics of hypospadias, and the scrotum is poorly developed and may have different degrees of opposite cleavage, and there are sometimes no testicles within it. 4 Perineal type: The external urethral orifice is located in the perineum, the external genital development is extremely poor, the penis is short and severely hypospadias, and the scrotum is divided, shaped like a female vulva, sometimes mistakenly raised as a girl. Symptoms ① abnormal urination, mainly manifested as a thin original line, service flow from the bottom without projection, wetting clothes and pants when urinating. ②The penis is obviously bent downward eyebrows when erect. Treatment Hypospadias must be surgically corrected. The purpose of surgery: First, to correct the downward bending deformity, the ventral fibrin of the penis needs to be removed and the penis completely straightened. Second, to shape the urethra and to position the opening as close to normal as possible. Surgical indications: Except for the coronal hypospadias, which can be done without surgery, all other types must be corrected by neck surgery. Surgical methods: According to statistics, there are more than 150 surgical methods. It should be treated differently according to the surgeon’s branch, the patient’s age and penile development. Generally speaking, the treatment is completed at an early age, which can eliminate the psychological impact of the patient, but the younger the age, the less cooperative, coupled with the small penis, the operation is difficult, so the chance of surgical failure increases. Therefore, some people advocate staged surgery, i.e., removing the fibrous cord at an early age, correcting the inferior flexion deformity, and then performing stage II urethroplasty after the penis has developed. Complication prevention and control Common complications include urethral fistula, stricture, wound infection and dehiscence, etc. Preventing complications is the key to success. Adequate preoperative preparation, delicate intraoperative operation and careful postoperative care can reduce the occurrence of complications. Diagnosis of hypospadias It is not difficult to diagnose hypospadias, but for the scrotal and perineal types, it is necessary to distinguish them from pseudohermaphroditic diseases. It is difficult to distinguish male scrotal and perineal hypospadias with bilateral cryptorchidism from male pseudohermaphroditism. In females, pseudohermaphroditism is due to congenital adrenal hydroxylase deficiency causing cortical hyperplasia resulting in an enlarged clitoris resembling the labia minora, with the urethral opening located at the root of the enlarged clitoris resembling hypospadias. The vagina is small and sometimes not easily detected, but the sex chromosome is xx. Plastic treatment of hypospadias Hypospadias is usually treated surgically. The purpose of surgery is to: correct the deformity of the penis, straighten the penis; reconstruct the urethra; remove the excess foreskin and reshape the head of the penis to make it look as perfect as possible. The surgery restores the normal function of urination and ejaculation. The plastic surgery of hypospadias has a history of more than 100 years and there are more than 200 surgical methods. Each method has its own strengths and weaknesses, and the surgical methods are mainly divided into two categories: one-stage surgery is to correct hypospadias and reconstruct the urethra in one operation; staged surgery is to first correct hypospadias and make a good transfer of the foreskin, and then perform urethral reconstruction after 6 to 12 months. The choice of surgical method should be flexible according to the type of hypospadias, the patient’s specific situation, and the experience and habits of the surgeon. Generally speaking, penile hypospadias can be operated in one stage, while scrotal and perineal hypospadias can be operated in one stage or in stages, depending on the situation. Most scholars believe that all treatment should be completed before school age.