Almost all complications in hypospadias surgery are related to non-anatomical reconstruction of the glanular urethra.
Dr Hüseyin Özbey
In normal human penis anatomy, the corpus spongiosum covers the urethra up to the mid-glanular (sub-coronal) level. After that level, a fibrous tissue (septum glandis) surrounds the glanular urethra (fossa navicularis), separates the two hemiglans, connects the upper and lower median septum and holds the glanular urethra in the midline as a suspensory ligament. The glans wings are separated by the 'septum glandis' and a ventral cleft between the glans wings that accommodates the frenulum, which is epidermally lined extension of the septum. Hence, the 'septum glandis' and frenulum are also included in the formation of the distal (glanular and subcoronal) urethra. In addition to a defective urethra and its corpus spongiosum, the 'septum glandis' and frenulum are entirely missing in hypospadias. The foreskin is not fused ventrally; it appears as a hood over the glans penis. Recent studies have shown that masculinization of the urethral plate occurs in association with the growth and fusion of the preputial fold along the ventral midline of the genital tubercle, which also forms the frenulum of the proximal part of the glanular urethra. Therefore, it is clear that formation of a normal glanular urethra, with its fossa navicularis, 'septum glandis' and frenulum are important indicators of an anatomical hypospadias reconstruction. This has inspired a hypospadias repair technique (GFC:Glanular-Frenular Collar technique) that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias.
The GFC technique aims to restore the functional anatomy of the glans with formation of the ‘septum glandis’ and frenulum between the glans wings, replicating the embryologic development of the glanular urethra. The GFC technique allows a tension-free tubularization of the glanular urethra, afforded by the limited spongioplasty. The space provided for the reformation of the fossa navicularis is supported by loose connective tissue (septum and frenulum) ventrally. The ventral aspect of the glans penis should not be covered (compounded) by the glans wings over its full length, in order to accommodate the frenulum. The GFC technique doesn’t necessitate glans dissection, is neither limited, nor extensive. Subepithelial approximation has been found to be anatomically and physiologically sufficient. With the GFC technique, normal urine flow (wave-like shape) is obtained in all patients.
Click here to read the article "HYPOSPADIAS REPAIR WITH THE GLANULAR-FRENULAR COLLAR (GFC) TECHNIQUE"
Click here to read the article "Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications"
Click here to read the article "Anatomical modeling of the foreskin for the reconstruction of glanular hypospadias"
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Click here to read the article "A closer look at iatrogenic hypospadias"
