An Anatomical Approach to Hypospadias Surgery: The GFC Technique
A surgical method based on the natural anatomy of the penis and urethra, designed to reduce the risk of fistula and stenosis, and equally applicable in cases of reoperative (recurrent) hypospadias.
GFC Technique
The GFC (Glanular-Frenular Collar) technique is a groundbreaking anatomical approach in modern 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 an MRI study. In accordance with historical anatomical drawings of the glans penis, our findings revealed that a fibroelastic tissue (septum glandis) covers the glanular urethra (fossa navicularis) circumferentially. It binds the glanular urethra to the distal ligament of the corpora cavernosa, and to the septum glandis, as a suspensory ligament on the midline. Hence, it may be true to say that reconstruction of the male urethra has been far from its normal anatomical features in the history of hypospadias surgery.
As the most anatomical repair, the GFC technique respects the natural features of the glanular urethra and delivers the most effective and satisfying results in hypospadias.
— Journal of Pediatric Urology, 2017;13:34e1–34e6
The GFC technique is a turning point in hypospadias surgery, based on the anatomical features of the penis, that have been overlooked in its history. 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. As an anatomically faithful reconstruction technique, the GFC technique yields the most effective and satisfactory results in patients with hypospadias.
In normal human penis anatomy, the corpus spongiosum covers the urethra up to the mid-glanular (sub-coronal) level. After that level, a fibroelastic 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 the epidermal cover 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 along the ventral aspect 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 involves reconstruction of the septum glandis, which has been overlooked in the history of hypospadias, and formation of the frenulum, creating the ventral wall of the glanular urethra without dissecting the glans, leaving room for the formation of the navicular fossa. The GFC technique aims to restore the functional anatomy of the glans, replicating the embryologic development of the glanular urethra.
Because of centuries-long misconceptions in repairing the male urethra, hypospadias surgery has become a complex procedure.
— Traditional misconceptions in hypospadias surgery, J Pediatr Surg, 2026
The GFC technique allows a tension-free tubularization of the glanular urethra, supported by spongioplasty confined strictly to the penile shaft. 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 approximated or fused over its full length, in order to accommodate the septum glandis and frenulum.
The GFC technique does not necessitate glans dissection—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, and 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 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.
Hypospadias repair should include reconstruction of the septum glandis, frenulum and fossa navicularis through a dual surgical approach for the glanular and penile urethra.
— The GFC technique: dual approach to hypospadias reconstruction, J Pediatr Urol, 2024
Traditional misconceptions in hypospadias surgery. J Pediatr Surg, January, 2026 (PDF)
- The male urethra is not a straight, uniform tube, as reconstructed in conventional 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.
- 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 natural midline “glans fusion”, this has unfortunately been routinely forced for decades during hypospadias surgery by dissecting the wings of the glans.
- The “septum glandis” is the fibroelastic tissue that 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.
- 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 biologically 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. Evidently, grafting the glans would have far more detrimental consequences.
Scientific References
This article was authored by Prof. Dr. Hüseyin Özbey, Pediatric Surgeon and Pediatric Urologist, based on current medical literature. You can view all scientific publications by Prof. Dr. Hüseyin Özbey here.
- Özbey H, et al. Hypospadias repair with the GFC Technique. J Pediatr Urol 2017;13:34e1–34e6. DOI
- Özbey H, Kumbasar A. Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI. Turk J Urol 2017;43:525–9. DOI · PMC
- Özbey H, Arlı OT. “Fossa navicularis” and “septum glandis”: a flow-control chamber for the male urethra? Med Hypotheses 2020;140:109642. DOI
- Özbey H. The mystery of Jacob Henle’s “septum glandis”. J Anat 2019;234:728–9. DOI
- Özbey H, Devecioğlu D, Staroverov O. A closer look at iatrogenic hypospadias. Andrologia 2020;53:e13803. DOI
- Özbey H. Anatomical modeling of the foreskin for the reconstruction of glanular hypospadias. J Pediatr Urol 2021;17:335–337. DOI
- Özbey H. The GFC technique: dual approach to hypospadias reconstruction. J Pediatr Urol 2024;20:539–540. DOI
- Özbey H. Boundary tissues and layers in the anatomy of the penis. J Pediatr Urol 2025;21:526–7. DOI
- Özbey H. Traditional misconceptions in hypospadias surgery. J Pediatr Surg 2026. DOI