Over the past two decades, assessment and treatment of associated curvature has emerged as a major issue in treating patients with proximal hypospadias. However, the cut-off for defining a curvature as clinically significant is still unclear, as not all patients are bothered by the same degree of curvature and, although the need for a method to assess the curvature objectively has been emphasized, no standard method yet exists. Curvature is multifactorial. The same degree of curvature can be due to any possible combination of skin and/or subcutaneous dartos tethering, a short urethral plate and an intrinsic corpora disproportion. Different strategies can be used to treat curvature, depending on the underlying cause, surgeon preferences, and the goals of the repair. In the past 10 years, use of urethral plate transection and ventral lengthening procedures has increased, although the lack of long-term follow-up data on ventral lengthening procedures suggests that the use of such procedures should be selective. Furthermore, straightening manoeuvres are influenced by the technique used for subsequent urethroplasty and, in turn, may influence the success rate of the urethroplasty. This Review provides a comprehensive overview of the major developments from the past 10 years in the management of severe proximal hypospadias in children.

在过去的二十年中，相关曲率的评估和治疗已成为治疗近端尿道下裂患者的主要问题。然而，将曲率定义为具有临床意义的临界值仍不清楚，因为并非所有患者都受到相同程度的曲率的困扰，尽管强调需要一种客观评估曲率的方法，但尚无标准方法存在。曲率是多因素的。相同程度的弯曲可能是由于皮肤和/或皮下 dartos 束缚、短尿道板和固有语料库不均衡的任何可能组合。根据根本原因、外科医生的偏好和修复的目标，可以使用不同的策略来治疗弯曲。在过去的 10 年里，尿道钢板横断和腹侧延长手术的使用有所增加，尽管缺乏腹侧延长手术的长期随访数据表明，此类手术的使用应具有选择性。此外，矫直操作会受到后续尿道成形术技术的影响，进而可能影响尿道成形术的成功率。本综述全面概述了过去 10 年儿童严重近端尿道下裂治疗的主要进展。可能会影响尿道成形术的成功率。本综述全面概述了过去 10 年儿童严重近端尿道下裂治疗的主要进展。可能会影响尿道成形术的成功率。本综述全面概述了过去 10 年儿童严重近端尿道下裂治疗的主要进展。