Objective <p>To evaluate the clinical efficacy of glanular decompression and expansion surgery in repairing proximal hypospadias accompanied by hypoplastic glans penis.</p> Methods <p>Clinical data from pediatric patients with proximal hypospadias and hypoplastic glans penis admitted to the pediatric surgery department of First People’s Hospital, Zunyi City from January 2020 to June 2023 were retrospectively analyzed. Patients were divided into two groups according to surgical approach: a conventional glanuloplasty group (<i>n</i> = 26) and a glanular decompression and expansion group (<i>n</i> = 28). Surgical outcomes, postoperative complications, penile growth, and satisfaction with postoperative penile appearance were compared and analyzed between the groups.</p> Results <p>No statistically significant differences existed between the two groups in preoperative baseline clinical data(<i>P</i> &gt; 0.05).In the conventional glanuloplasty group, complications occurred in 10 cases (38.46%),including glanular dehiscence in 4 cases (15.38%), urethral stenosis in 2 cases (7.69%), urethral fistula in 3 cases (11.54%), and recurrent penile curvature in 1 case (3.85%). In the glanular decompression and expansion group, 6 cases (21.43%) experienced complications, comprising urethral fistula in 3 cases (10.71%), urethral stenosis in 2 cases (7.14%), urethral diverticulum in 1 case (3.57%),and no cases of glanular dehiscence. The incidence of postoperative glanular dehiscence was significantly lower in the decompression and expansion group compared with the conventional group (<i>P</i> = 0.047),There were no statistically significant differences in the overall complication rate, incidence of urethral fistula, or urethral diverticulum between the groups (<i>P</i> &gt; 0.05).One year postoperatively, the glanular width in the decompression and expansion group was significantly greater than that in the conventional group (1.34 ± 0.13&#xa0;cm vs 1.40 ± 0.08&#xa0;cm; <i>P</i> = 0.031).</p> Conclusion <p>Glanular decompression and expansion surgery effectively reduces the incidence of postoperative glanular dehiscence in proximal hypospadias patients with hypoplastic glans penis. Additionally, this technique enhances glanular size and improves the satisfaction of physicians and patients’ families regarding penile appearance. However, its efficacy in reducing urethral fistula and overall complication rates remains limited.</p>