Hypospadias is the most common congenital penile malformation, typically repaired in early childhood. However, many individuals present in adulthood with complications, including voiding dysfunction, chordee, cosmetic dissatisfaction, sexual dysfunction, and infertility. This chapter reviews the classification, etiology, and epidemiology of hypospadias and details complications and reoperations associated with pediatric surgical repair. This chapter also provides an overview of common presenting complications, assessment, and surgical management. Adult assessment emphasizes thorough history and physical examination, with targeted evaluation of urinary, sexual, and cosmetic outcomes. Psychosocial outcomes, including medical trauma, are underreported but clinically relevant. Finally, a shifting paradigm toward deferring surgery in mild cases underscores the need for shared decision-making and lifelong outcomes tracking. As more patients present with unrepaired or reoperative needs in adulthood, reconstructive urologists must adapt care with trauma-informed and patient-centered principles.