Hypospadias is the most common congenital malformation in the male genitourinary system, with an incidence of 1/250 to 300 in male newborns worldwide and 4.3/1000 in China, and the trend is increasing year by year. According to the literature, there are more than 200 surgical repair methods for hypospadias so far, and the increase in the number of patients has led doctors in general surgery, urology, pediatric surgery, and plastic surgery to get involved in the field of surgical repair of hypospadias, which shows that there are still many debatable aspects of hypospadias. The goals of today’s hypospadias surgery are: (1) a straightened penis; (2) migration of the external urethral opening to the tip of the penile head; (3) normal erection and urination; (4) establishment of a proper and consistent diameter urethra; and (5) symmetrical appearance of the glans and penis. There are many surgical methods for hypospadias, and the current main application of one-stage urethroplasty can be divided into three types: (1) using the skin adjacent to the urethral opening instead of the urethra; (2) using island skin with a vascular tip instead of the urethra; and (3) using free grafts instead of the urethra. However, for the treatment of hypospadias, should one stage surgery or staged surgery be chosen? There is still a controversy. We believe that the preferred treatment for the majority of hypospadias is one-stage surgery, and our views are as follows. In the 1950s and early 1960s, the success rate of this procedure was reported to be below 50%. Browne method in 1965 reported a success rate of 80% to 90% or more. However, staged surgery has a long treatment period, which increases the psychological and treatment cost burden of patients. Moreover, it has been reported in the literature that the greater the number of surgeries in the treatment of hypospadias, the greater the impact on the patient’s postoperative sexual function. Some authors have shifted to two-stage surgery due to unsatisfactory results of one-stage repair for severe hypospadias. The Japanese scholar Koyanagi used the basal flap of the external urethral opening and the surrounding foreskin flap for urethroplasty, the new urethra does not need to be anastomosed with the original urethra, and the one-stage surgery can usually be completed for proximal hypospadias (scrotal or perineal type, etc.) Duckett believes that with the application of penile and scrotal flaps, the most severe hypospadias can be urethroplasty in one stage, and there is no need to return for another staged surgery. In China, Professor He also believes that one-stage urethral hypospadias repair has withstood the test of time and fully confirmed its feasibility, and most of the hypospadias can be operated in one stage. 2. Advantages of one-stage surgery In 1900, Russell first tried one-stage hypospadias repair, and then the development of one-stage surgery was slow for a long time. With the new understanding of the surgical treatment of hypospadias, the one-stage hypospadias correction and urethroplasty surgery for hypospadias has developed greatly, and the success rate of one-stage surgery has reached more than 90%. Especially after the introduction of the artificial erection trial by Gittes and MeLaughlin in 1974, it was not until after the 1970s that the one-stage procedure was more fully recognized again and also gradually became a mainstream procedure. Asopa in India and Hodgson in the United States proposed a similar approach in which the inner foreskin island flap was transferred as a patch or formed into a tube and transferred together with the outer foreskin as a whole, with the outer plate serving as a cover and the inner plate repairing the urethra.In 1980 Duckett designed the transverse tipped island foreskin flap procedure based on the improvement of the Asopa and Hodgson procedure ( Duckett procedure), and shortly thereafter introduced the urethral orifice advancement, penile headplasty (MAGPI), and tipped island foreskin flap with preservation of the urethral plate as a cover (Onlay island flap). Although there are various surgical procedures, until now there is no one specific procedure for all types of hypospadias, but one-stage surgery is more acceptable to patients and families than staged surgery, and its significantly shorter treatment period of staged surgery, also reduces the pain and medical costs of multiple surgeries, and does not reduce the success rate of surgery, and its complications are not significantly increased compared with staging. in 1994, the Snodgrass reported urethral plate longitudinal coiled urethroplasty, which has the tendency to replace other surgeries because of its good surgical results and relatively simple operation procedure. At present, the main application of one-stage urethroplasty can be divided into three kinds: ① Using the skin adjacent to the urethral opening instead of the urethra: In 1981, Duckett first reported this MAGPI procedure, and only one case of urinary fistula occurred in more than 200 patients. In China, Li Jichu reported 25 cases of hypospadias of penile head type or coronal sulcus type treated with this procedure with satisfactory results. It is to move the external urethral opening forward to the glans proper through the glans median incision and the covering of the two lateral glans flaps, which is simple to operate, reasonably designed, and has good surgical effect. After the postoperative correction, the urethral opening is in the glans proper, perfect in appearance, basically similar to normal, and has few complications. ②Use of island skin with vascular tip instead of urethra: the skin on the dorsal side of the penis has a rich blood supply, and it is very easy to use the skin flap with tip as a patch, which is as easy as a hand. At the same time, because the skin with the tip has blood circulation, it can heal quickly, but it should be noted that the tip should not be overly distorted or pressured, and do not put pressure on the bandage after surgery, so as not to affect ischemic necrosis. Those who do not have sufficient skin in the dorsal foreskin flap-taking area will result in greater tension in the penile skin suture, causing penile distortion or poor healing. The Snodgrass method is a popular one-stage surgical treatment for hypospadias in Europe and the United States today, with a high success rate, and has gradually become the recommended procedure for many urologists and plastic surgeons. In recent years, this procedure has been extended to severe hypospadias such as proximal penile body and penile scrotal junction type and perineal hypospadias, and has been promoted for its good surgical effect and relatively simple operation procedure, and also has the characteristics of convenient extraction, strong resistance to urinary erosion, rich blood supply and easy survival, no hair and stones, easy operation and few postoperative complications. There is even a trend to replace other surgeries. The scrotal flap should be in the midline hairless area of the scrotum, ignoring the presence of hair follicles that can lead to hair growth in the urethra. 1989, He Xu Xu reported a group of severe hypospadias phalloplasty with a combined scrotal flap of the curved tipped penis, and the success rate of the operation was 93.3%. The principle of this procedure is based on the anatomical characteristics of two layers of penile skin vessels, easy separation of the two layers, fixed blood flow in the longitudinal scrotal septum, and abundant vascular branches at the junction between the two. ③Use of free grafts instead of urethra: there should be free skin, bladder mucosa and buccal mucosa graft for urethroplasty, because the tissue structure is different, each has advantages and disadvantages, all can obtain more satisfactory results. The inner foreskin trigger is soft and elastic, and the surface of the bladder mucosa is covered with urethral migration epithelium, which is thin and extensible and resistant to urine impregnation, and it is easy to take the material, and enough mucosa can be cut at will to reconstruct the perineal hypospadias, without affecting the cosmetic effect. The surface of buccal mucosa is covered with compound flat epithelium, the surface layer is not keratinized, the surface is moist, the mucosa is stronger and softer, it can be thinned at will without affecting the healing, it is the ideal material as urethra, but it needs to be taken under general anesthesia. 3. Points to note for one-stage surgery: the surgical experience of the operator, the local deformity of the patient, the urethral covering barrier and the quality of the suture are important conditions to guarantee the success of the surgery. Preoperative evaluation of the anatomical defects of the penis and urethra, estimation of the available foreskin, penile and scrotal skin area, and how to reduce postoperative complications such as infection, urethral stricture, urinary fistula and graft contracture are important steps in the preoperative planning of the surgery. The operator should weigh the various aspects of the plan and aim for a one-stage reconstruction with minimal postoperative complications. The choice of the appropriate surgical approach is an important factor in the final outcome of the procedure. The selection of the surgical approach should be based on the following principles: first, the surgeon should be skilled in several different surgical approaches with different characteristics to cope with different lesions; second, the selection of the repair and reconstruction tissue material should be based on the local lesion characteristics of the patient; third, attention should be paid to the anatomical level when separating and suturing the flap to protect its blood flow; fourth, the urethral covering “barrier” Fourth, the urethral coverage “barrier” should be tension-free suture and multilayer misaligned coverage; Fifth, patients with local repair conditions too poor to achieve one-stage repair should not force one-stage, but can also consider staged surgical treatment to achieve better results. At present, for the treatment of hypospadias, one-stage surgery is the first choice, but when treating patients, we should master various surgical methods, choose the appropriate surgical style according to different types, and try to achieve one-stage formation, instead of using a single surgical style in a uniform manner. There are different surgical methods for different hypospadias, and different surgical methods are available for the same hypospadias. Hypospadias in the same patient can also be done in one or two ways. It is generally believed that: ① if the urethral plate is wide and well developed, the Duckett-Duplay method can be used; ② if the urethral plate is narrow and cannot be rolled, the Snodgrass and Onlay island flap methods can be used; ③ if the urethral plate cannot be preserved, the tipped flap or free tissue substitute urethra can be used, such as the Duckett method or the mucosal method. With the accumulation of experience, technical improvement and proficiency, all can obtain satisfactory results.