1.What is hypospadias? How to determine the severity of hypospadias? Hypospadias is one of the most common congenital malformations in males. Clinical diagnosis of hypospadias generally includes the following points: (1) The location, shape and width of the urethral opening. (2) The development of the urethral plate and the bifurcation spongiosum (3) The appearance of the “turban”-like foreskin and the condition of the scrotum. (4) The size of the penis. (5) The degree of penile curvature during erection. The presence of other associated abnormalities such as cryptorchidism, syringomyelia, etc. should also be noted in the evaluation of hypospadias. Severe hypospadias is often associated with unilateral or bilateral cryptorchidism, hermaphroditism, etc. In this case, thorough genetic and endocrinological testing is required to rule out hermaphroditism, especially congenital hyperadrenocorticism. Except in the rare cases of severe hypospadias, the incidence of upper urinary tract anomalies in children with hypospadias is generally similar to that of the general population. 2. Why do you get hypospadias? It is now believed that the development of the penis and urethra is a “delicate” process that requires correct genetic programming, hormonal actions (mainly testosterone and its 5 alpha reduction product: dihydrotestosterone), timely cell differentiation and complex inter-tissue interactions. A malfunction in any of these processes may result in a hypospadias, where the ventral urethral corpuscles of the penis are not properly developed, resulting in an ectopic urethral opening anywhere from the coronal sulcus to the perineum, known as hypospadias. The occurrence of hypospadias may be due to insufficient androgen synthesis, androgen insensitivity, and exogenous anti-androgen-like effects, either alone or in combination. However, the molecular mechanisms underlying the development and progression of hypospadias have not yet been elucidated. According to the 2010 European Urological Association Guidelines for Paediatric Urology, possible risk factors for hypospadias are: (1) A definite endocrine disease etiology can be found in a very small number of cases. (2) Mothers who give birth too early or too late and low birth weight of the newborn are a high risk factor for hypospadias. (3) The incidence of hypospadias has increased significantly in the last 20 years, suggesting that environmental factors are important in the development of hypospadias (hormone disruptors and insecticides, etc.). However, a history of oral contraceptives before pregnancy does not increase the incidence of hypospadias in offspring. 3. What makes a successful hypospadias repair? The surgical treatment of hypospadias has changed significantly over the last 20 years or so, and the treatment of hypospadias is no longer limited to surgery! The treatment of hypospadias can be understood as a systemic project. The treatment of hypospadias encompasses all areas of organ aesthetics, sociology, sexual health, sexual function and mental health. Hypospadias surgery is only one important part of the treatment project, which is essentially plastic surgery. Restoring an acceptable appearance and creating a functional urethra are the basic goals of the surgery. Pediatric urologists cannot consider the ability of the child to urinate standing up, the absence of strictures and the absence of urinary fistulas as a sign of successful surgery. The end result of treatment for hypospadias in the vast majority of cases should be a penis that can perform almost normal ejaculation and complete sexual intercourse in addition to normal urinary function, one of the most important factors in completing sexual intercourse is the size of the penis.