HYPOSPADIAS SURGERY

In hypospadias surgery, tubularization of the neourethra over a catheter or stent and approximation of the dissected glans wings on the midline to enclose the neourethra have been the standard surgical method for decades. However, the male urethra is not a tubular structure with uniform configuration and diameter. The "fossa navicularis" (terminal/glanular portion of the male urethra) has distinct attachments with the "septum glandis" and "frenulum". Recently, we documented the anatomical features of the glans penis with MRI study. In accordance with previous historical drawings of the glans penis, our findings revealed that a fibrous tissue (septum glandis) covers the glanular urethra (fossa navicularis) circumferentially. It binds the fossa navicularis to the frenulum and corpus cavernosum, as a suspensory ligament on the midline. Hence, it may be true to say that reconstruction of the glanular urethra has been far from its normal anatomical features for decades.

The GFC technique is a turning point in hypospadias surgery, which is based on the anatomical features of the penis that are not taken into account since decades. With the GFC technique, the anatomical features of the glanular urethra, in particular the "fossa navicularis", "septum glandis", "frenulum" and the "shape of the normal urine stream" are taken into account for the first time. As being the most anatomical repair, the GFC technique gives the most effective and satisfactory results in hypospadias.

Traditional misconceptions and evidence-based anatomical facts in hypospadias surgery:

1. The male urethra is not a straight, uniform tube, as reconstructed in all hypospadias repair techniques. It has the “fossa navicularis”, which forms the glanular urethra with specific functional properties. The glans is not an anterior extension or expansion of the corpus spongiosum, which gradually terminates at the mid-glanular level. A faulty development of the fossa navicularis indicates a malformation of the glans itself, manifesting as grooves of varying depth on the glans.

2. The glans tissue does not completely enclose the navicular fossa, but is separated by the “septum glandis” along the ventral midline. Although there is no “glans fusion”, this has unfortunately been routinely achieved for decades during hypospadias surgery by dissecting the wings of the glans.

3. The “septum glandis” is the fibroelastic tissue, which covers the fossa navicularis. As a fibroelastic partition, the septum glandis provides the elasticity and adaptive configuration of the glanular urethra during micturition and ejaculation. Together with the frenulum the septum glandis forms the ventral wall of the glanular urethra.

4. The “distal ligament” contributes significantly to the flexibility and rigidity of the glans, particularly during sexual intercourse. A deep midline incision of the glans is equivalent to a direct visual internal urethrotomy, corresponding exactly to the position of the distal ligament, which has reportedly led to erectile dysfunction in patients following hypospadias repair. Apparently, grafting glans would have far more detrimental consequences.

Traditional misconceptions in hypospadias surgery. J Pediatr Surg, January, 2026