Hypospadias is one of the most common congenital malformations of the pediatric genitourinary system. Causes: 1. Genetic factors There is a genetic predisposition to the development of hypospadias, but the specific genes or chromosomes involved are not yet known. Hormonal influences Hormones produced from the fetal testis affect the formation of male external genitalia. Insufficient or late production of testosterone or abnormalities in the process of converting testosterone to dihydrotestosterone can lead to genital malformations. Clinical manifestations: 1. Ectopic urethra: The urethra can open anywhere from the proximal end of the normal urethra to the perineum, and the affected child often takes a squatting position to urinate. 2, ventral bending of the penis: mainly due to hyperplasia of the fibrous tissue of the urethral plate distal to the urethral orifice, lack of tissue in the ventral side of the penis and the layers of the urethral wall, and asymmetry of the dorsal and ventral sides of the penile corpus cavernosum. 3. Dorsal prepuce accumulation: the ventral prepuce of the head of the penis fails to fuse in the median line, the prepuce tether is absent, and all the prepuce is turned to the dorsal side of the penis and accumulates in the shape of a cap. Complications: The most common associated deformities of hypospadias are inguinal hernia and incomplete testicular descent. The more severe the hypospadias, the higher the incidence of concomitant malformations. Occasionally, hypospadias is associated with upper urethral malformations such as hydronephrosis, duplication of malformations, and in a few patients, anorectal malformations. Diagnosis: The diagnosis of hypospadias is not difficult and can be determined at first glance. However, attention should be paid to the presence of combined malformations or gender anomalies, and chromosomal examination should be performed in cases of ambiguous external genital performance, severe hypospadias or hypospadias combined with cryptorchidism or micropenis. Treatment: One-stage surgery or staged surgery can be used. We mostly use one-stage urethroplasty. The goal of the surgery is to completely correct the downward curvature of the penis, the opening of the urethra in the glans, the ability of the patient to urinate in a standing position, and the ability to have a normal sexual life in adulthood. The best age for surgery is currently recommended to be around 1-1.5 years old after birth. If the penis is too small (e.g., glans diameter less than 12 mm), topical dihydrotestosterone or testosterone or HCG injections are needed to promote penile growth before surgery, usually 1-2 months after stopping the medication. The main complications of surgery: urethral fistula, urethral stricture, urethral diverticulum formation, penile re-curvature, etc. The overall incidence is about 30%. The overall incidence of these complications is about 30%. The above complications require reoperation, and the reoperation should be performed at least six months after surgery.