Proximal Hypospadias: One Stage or Two?

Proximal hypospadias creates one of the oldest disagreements in pediatric urology: should repair be performed in one stage, or should it be staged?This episode reframes the debate away from surgical ideology and toward biological risk.The central question is not how many operations the child should have. The central question is how much curvature correction, urethral reconstruction, glans closure, tissue coverage, and wound healing can safely be placed into one operative event.In this episode, we discuss a practical three-gate framework for decision-making:Straightness.Tissue quality.Healing predictability.We also examine why urethral plate transection becomes a major pivot point in proximal hypospadias surgery, why comparative studies are difficult to interpret, and why staging should be understood as risk control rather than failure.This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.