Abstract： Objective:To explore the prognosis and influencing factors of proximal hypospadias based on multicentre data.Methods:From December 2018 to December 2019, clinical data were retrospectively reviewed for children with proximal hypospadias initially admitted into 15 children's medical centers in China with complete follow-ups. The subjects were assigned into groups according to different urethroplasty approaches. A total of 549 cases fulfilled the criteria, including TIP 9.5% (52/549) , Onlay 4.7% (26/549) , Duckett 59.2%(325/549), Duckett plus Duplay 5.5%(30/549), Koyanagi 9.7%(53/549) and staged operation 11.5%(63/549). Therapeutic outcomes and prognostic factors of different surgical approaches were analyzed.Results:Penile traction length averaged 3.68 cm, penile head length 10.5 mm, penile head width 10.5 mm, urethral defect length 3.52 cm and penile curve 57.5 degrees. Statistically significant differences existed in urethral defect length and penile curvature among all groups ( P<0.001). In TIP group, 88.5% urethral plate had an excellent elasticity. Statistically significant differences existed in elasticity/flatness of urethral plate among different surgical groups ( P<0.001). The average follow-up period was 26 months. The overall complication rate was up to 43.7%(240/549). The complication rate was 30.8% (16/52) in TIP group, 38.5% (10/26) in Onlay group, 52.9% (172/325) in Duckett group, 40% (12/30) in Duckett+Duplay, 30.2% (16/53) in Koyanagi and 22.2% (14/63) in staged operation. The incidence of postoperative complications differed greatly among six groups ( P<0.001). Conclusion:The management of proximal hypospadias remains problematic and the postoperative complication rate of one-stage operation is 30.2%-52.9%. Operations should be customized according to the specific conditions of penis. TIP is contra-indicated for proximal hypospadias with poor flatness or elasticity of urethral plate or severe concomitancy of ventral curvature. However, transverse urethral plate may be adopted. For long urethral defect with severe ventral curvature, staged operation is selected.