Hypospadias is a common malformation of the male genitourinary system, and Galen was the first to use the term “hypospadias” to describe it in 200 AD. The incidence of hypospadias in newborns is reported in the literature as 1/300, with geographical and ethnic differences, with a prevalence of 0.8 to 8.0 per 1,000, and is closely related to environmental pollution brought about by industrial development. Hypospadias not only causes disorders of urination and sexual and reproductive ability, but also affects the psychological development of the patient and brings great pressure to the family. Regarding the treatment of hypospadias it is always a difficult problem to achieve both near normal morphology and perfect function. We have reviewed the literature on the surgical treatment of hypospadias in the past 5-10 years at home and abroad and review it as follows. I. Suburethral cleft typing 1. Typing according to the anatomical location of the external t71 of the urethra Suburethral cleft is divided into 4 types, namely type I: penile head and coronal groove type; type II: penile body type; type III: penile scrotum type; type IV: perineum type. Or it is divided into penile head type, distal penile type, proximal penile type, penile scrotum type and perineum type. However, this typing cannot correctly reflect the degree of penile recurvature as well as determine the location of the external urethral opening and the length of the reconstructed urethra after the penis is straightened, which is of little significance for the selection of the appropriate surgical method. 2.Typing according to the degree of penile curvature” Because hypospadias is often accompanied by penile curvature, it can be divided into mild, medium and severe penile hypospadias according to the degree of curvature. 3.Typing according to the position of urethral recession after correction of penile flexion deformity The hypospadias is divided into: proximal hypospadias (penile head type, coronal groove type, penile anterior 1/3), middle hypospadias (penile middle 1/3), and distal hypospadias (penile anterior 1/3, penile scrotum type, scrotum type, perineum type). This typing can accurately reflect the severity of hypospadias, therefore, we think it is more appropriate to use this type of method. The history of the surgical procedure of hypospadias repair can be traced back to 100-200 A.D. At that time, the location of the deformed external urethral opening was the fixed point, and the distal penile body of the external urethral opening was considered to affect urination and was a useless part, so the surgical method at that time was to treat hypospadias by cutting off the distal penile stem of the external urethra t71 . It was later found that this surgical procedure was not physiologically correct and that it affected male sexual activity. After research, it was found that by loosening and straightening the flexed penis, not only could the penis be changed to a normal shape, but it could also be made longer. However, a new problem arises when the external urethral opening is lower than before. In this case, the penis can be inserted into the vagina for sex, but the semen cannot be ejaculated into the female vagina. In the mid-1950s, the first-stage urethroplasty was developed, but it was mainly represented by the staged Denis-Browne procedure. After that, the Hodgson, Mustarde, Mathieu, the external urethral orifice advancement phalloplasty (MAPGI), the double-bread flap replacement urethra, the scrotal mid-suture flap replacement urethra, and the mucosal urethroplasty of the bladder emerged, but at that time, the various surgical procedures were still relatively unstable and had more postoperative complications. Later, various vascular flap urethroplasties with tipped flaps emerged, with the TIP (Snodgrass) procedure, the Onlay island flap method, and the Duckett procedure or its modifications being the classics. The timing of surgery for hypospadias is of great importance to the physiological and psychological trauma of the patient, and there is no consensus on whether it should be performed in infancy or before school age. Foreign scholars believe that the ideal age for initial repair of hypospadias is 6 to 18 months, and another acceptable age for surgery is 3 to 4 years. These two periods reduce the physiological and psychological impact of the surgery on the child, as well as the psychological burden on the parents. There are also two opinions among domestic scholars: (1) A few scholars, considering the psychological and penile development of the affected children, favor performing the corrective surgery in infancy so that the infant will not be left with adverse effects due to the local deformity. (2) Most scholars propose to complete all surgeries before school age according to our national conditions, including the interval between staged surgeries and the management of possible complications. They believe that the main factors affecting early surgery are the risk of anesthesia, the technical difficulty of surgery and postoperative care, etc. The tolerance of children aged 3 to 4 years for surgical anesthesia has improved significantly compared with that of infants and children, which facilitates perioperative management and is conducive to successful surgery. 2. There are quite a lot of surgical methods for hypospadias, and each founder of the surgical method has his own philosophy, but the goals and objectives are the same, that is, to achieve: (1) complete correction of penile flexion deformity and reconstruction of the defective urethra; (2) the function and form of the penis as perfect as possible; (3) close to normal standing urination, and the ability to perform normal sexual life status in adulthood. Therefore, several factors should be taken into consideration when choosing the surgical procedure, including the development of the penile corpus cavernosum, the degree of curvature, the position of the urethral opening, the presence or absence of stenosis, the development of the foreskin and urethral plate, etc., rather than judging the severity of the deformity simply by the position of the external urethral opening. Although there have been more than 300 surgical procedures for hypospadias from the creation of surgical treatment of hypospadias to the present, we found in our review of the literature that the main difference lies in the choice of urethral reconstruction material selection method and whether or not to stage. 3. Urethral reconstruction material selection In the surgery of hypospadias, different materials have been tried to reconstruct the urethra, such as: tipped flap taken from the penile foreskin or scrotum, full-thickness free flap; bladder or buccal mucosa; ureter, arteriovenous and appendiceal tissues. With the development of various urethral replacement material procedures, there is a greater understanding of the materials used to replace the urethra. Scholars working in this field believe that the material used to reconstruct the urethra depends on the length of the repaired urethra and whether the procedure needs to be completed in stages. Currently, the preferred urethral replacement material tends to be: (1) penile foreskin: it has the advantages of being easily viable, stretchable, soft, free of hair growth, easy to take, and easy to design and trim. However, the material is limited and prone to scar contracture and urethral stricture. (2) Bladder mucosa: It is highly adaptable to urine, easy to obtain and can be trimmed accordingly to the urethral defect. It is often used as reserved in cases of severe hypospadias or long urethral defects where foreskin retrieval is not sufficient to repair the urethra. In long-term follow-up, it was found that the transplanted bladder mucosa was closer to normal urethral tissue, giving an excellent and stably usable material for urethral reconstruction, and could grow with age without affecting the appearance with satisfactory results. (3) Buccal mucosa: In the past 10 years, buccal mucosa has been applied to the reconstruction of defective urethra and is expected to be a more satisfactory material for urethral replacement. However, the extraction of material is limited and the tissue source is different compared to urethra. (4) Scrotal skin flap: rich blood supply, forming urethra is not easy to necrosis, but scrotal skin is rich in hair, to adult can appear urethral hair growth and urethral stone formation, and can form urethral stricture, the long-term effect is not very satisfactory. (5) Tissue engineering materials: by obtaining normal tissue cells or replacement cells, regulating the growth and proliferation of the cells in vitro, using synthetic scaffolds or biological scaffolds as carriers, and implanting them in vivo to allow the cells to continue to grow and eventually shape into the desired normal tissues and structures. atala et al. used a scaffold made from the collagen matrix of the submucosa of the donor bladder, with the help of a covered flap to repair hypospadias, which has been successfully used in experimentally and clinically. Tissue engineering technology is now one of the most promising means of urethral reconstruction. At present, this technology has been carried out in China, and our hospital is gradually using tissue engineering technology to reconstruct the urethra. 4.The choice of urethral reconstruction method is based on the development of the penis, the length of the urethral defect, the amount of the dorsal foreskin of the penis and the habit of the operator. (1) For proximal hypospadias or urethral defect <2.5 cm, anterior urethral extension and MAGPI are mostly chosen, but MAGPI is still the classic procedure for correction of penile head type and coronal hypospadias, and the efficacy is sure, but it is difficult to correct penile hypospadias. (2) The more selected procedures for mid-portion hypospadias are Duckett procedure, TIP (Snodgrass), Onlay island flap method, Mathieu method and other methods. In China, the Duckett procedure and its modifications and the free bladder mucosa method are mainly used, while in foreign countries, the 11P procedure with preservation of the urethral plate is mainly used. (3) In the case of distal hypospadias, free bladder mucoplasty is chosen. The surgical treatment of this type of hypospadias is still a challenge. cilento l in 2002 summarized the treatment methods for this type of hypospadias, mainly the bladder mucosa graft method, the transverse island flap method, the island flap with cover method, the free skin slice (Devine-Horton) method, and the buccal mucosa graft urethroplasty, TIP procedure. (4) For those who have failed multiple surgeries, the current recommended surgical approach is to perform bladder mucosal or buccal mucosal surgery in stages. (5) Staging of urethral reconstruction surgery Current scholars in this field tend to use one-stage urethroplasty. There are many advantages of one-stage surgery, but in practice it is still limited by the limited material available for reconstructive urethra, the lack of ideal penile corpus cavernosum extension, and the controversial choice of the best treatment for hypospadias. In 2002, Samuel proposed that staged surgery for hypospadias was superior to staged surgery in terms of length of stay, operative time, function, appearance, and complications.Greenfield analyzed a large body of literature and found that the majority of cases required reoperation after staged surgery, which was explained by the fact that in adulthood The reason for this is that the penis remains curved in adulthood and the diameter of the initially reconstructed urethra is not adequate for urinary and reproductive needs. He noted that staged surgery remains the treatment of choice for most cases of proximal hypospadias with severe flexion, and Gershbaum conducted a 5-year follow-up of stage I and stage II surgery for severe hypospadias with severe hypospadias and varying degrees of penile and scrotal transposition, and found that stage II surgery was more effective than stage I surgery in terms of postoperative function and appearance. Hypospadias surgery is diverse and has its own strengths and weaknesses, especially complex hypospadias remains a challenging problem for urological clinicians, who should have basic knowledge and practical experience in urology, pediatric surgery and plastic surgery.