Mr. and Mrs. Binbin are happy to add a son, but the couple is hardly the joy of other families adding a child. It turned out that the child’s penis grew differently from other children, the child’s penis was poorly developed, the foreskin covered the glans like a turban, did not wrap the glans, the urethral opening did not open at the glans, but in the middle of the penis body, the glans could not be erected normally, but bent ventrally. When he arrived at the children’s hospital, he learned that the child was suffering from a congenital malformation called hypospadias. 1, the cause of hypospadias Why does the child suffer from hypospadias? (1) Genetic factors: Hypospadias is polygenic and has a clear family tendency. (2) Environmental factors: The fetal urethra is formed during 8-15 weeks of gestation, during which testosterone deficiency can cause the urethra to stop developing and cause hypospadias. Studies have found that a higher percentage of newborns with hypospadias occurred in mothers who took progesterone early in pregnancy. (3) The influence of drugs: pregnant women who take certain drugs early in pregnancy, especially anti-epileptic drugs are prone to induce hypospadias. 2, there are several types of hypospadias (1) penile head type: this type is the most common, the deformity is the lightest, the urethral orifice is located in the prepuce tether, and the tether is absent, the head of the penis is not obviously recurved to the ventral side, there is no obvious membrane urethra, surgical correction is easier. (2) Penile body type: the urethral orifice is located in any part of the penile body, combined with different degrees of ventral flexion and recurvation of the penile body. Generally speaking, the heavier the penile recurvature, the poorer the development of the penile urethral plate, and the more difficult it is to correct surgically. (3) Penile scrotum type: the urethral opening is located at the junction of the penis root and scrotum, the penis is severely bent ventrally, the scrotum is often split against the scrotum, and the concomitant cryptorchidism resembles the female labia. (4) Perineal type: the urethral orifice is located at the perineum, the penis body is extremely recurved ventrally, the dysplastic penis is often covered by the foreskin and split scrotum, the external genitalia resembles female, if combined with cryptorchidism, the male pseudohermaphrodite. Some serious deformities need to check chromosomes to exclude true hermaphroditism. 3.How to treat hypospadias Surgery is the only treatment method. The best age for surgery is usually 1-3 years old, because the child’s memory is not obvious, the psychological trauma is small, and it does not affect school later. Surgery from 6-18 months is also advocated. Children with mild hypospadias or those who do not have significant penile hypospadias can be orthopedic in one stage, with a good prognosis and a cure rate of more than 90%. Severe hypospadias can be performed in two stages, with hypospadias straightening in one stage to correct the penile hypospadias and urethroplasty in the second stage after 6 months. Severe hypospadias can also be done in one stage, and the usual procedure is Duckett or Duckett + Duply. There are advantages and disadvantages to both stage I and stage II surgery for severe hypospadias, and they can be chosen according to the condition. For penile body dysplasia and short penis, 1-2 courses of chorionic gonadotropin (HCG) can be tried, and the penile body will develop to a certain extent before surgery. 4, what are the common complications after hypospadias Common complications are urethral fistula, infection, urethral stricture (1) urethral fistula: the most common postoperative complications, heavy hypospadias generally have a high incidence, most of the small urethral fistula formed in the early postoperative period can heal on their own, but also local application of complex iodine or antibiotic solution flushing. If the fistula still does not heal after six months, repair of the fistula is feasible. (2) Infection: Infection in hypospadias can be caused by many reasons, such as local bleeding hematoma, urinary tract infection, poor nutritional status, low resistance, and wound contamination. Postoperative antibacterial drugs should be given. (3) Urethral stricture: The common stricture site is the anastomosis or external urethral orifice, mostly seen in heavy hypospadias, which has a low incidence but is difficult to deal with. Early urethral dilatation is feasible, and resection of the stenotic segment and urethrostomy can be considered if it is ineffective. 5.Postoperative care of hypospadias (1) Urethral tube care: avoid prolapse, distortion, prevent compression, encourage more water, keep urine clear, prevent blockage of urethra. (2) Combined infections should be flushed with gentamicin saline solution and coated with complex iodine: keep stools open Can take liquid paraffin or eat fiber-rich food orally to prevent difficult stools and wound bleeding and cracking. In older children, give enestradiol to prevent penile erection.