An Anatomical Solution in Hypospadias Surgery: The GFC Technique

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. The detailed anatomy of any organ and/or malformation can be further defined based on new knowledge, as in hypospadias. The anatomical differences between the glanular and penile urethra, the structures such as the septum glandis and the fossa navicularis are new definitions that have led to a paradigm shift in hypospadias. The finding that the wings of the glans are not fused together ventrally but are separated by the septum glandis represents a new insight and clarifies the causes of the complications that frequently occur in hypospadias, such as meatal stenosis, fistula and the so-called glans-dehiscence. Reconstruction of hypospadias should include the formation of a septum glandis, frenulum, and navicular fossa with a dual surgical approach for glanular and penile urethra reconstruction.

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

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.