Summary
Background
In the normal human penis, the glans wings merge in the midline ventrally, but are
separated by the ‘septum glandis’ in conjunction with the frenulum. The frenulum is
also included in the formation of the distal (glanular and subcoronal) urethra, which
has a special part known as the ‘fossa navicularis’. This has inspired a hypospadias
repair technique that simulates the development of the glanular and subcoronal urethra,
which can be incorporated into the repair of all cases of hypospadias.
Material and method
A total of 121 patients with varying degrees of hypospadias underwent surgery with
the described technique: a Y-V plasty was used to dissect the inner foreskin, in a
fashion that allowed for its ventral mobilization as a frenular mucosal collar. After
tubularization of the proximal urethra, a partial spongioplasty was performed that
extended up to the subcoronal level. The glans wings were approximated only at their
outermost convexities, with a couple of subepithelial sutures, leaving a slit for
the meatus. The cleft-like area between the split wings of the glans penis was filled
with the terminal ends of the spongiosum and the dartos of the mucosal collar, which
converged to form a septum and a neo-frenulum (glanular-frenular collar, GFC). The
midline skin closure of the ventral collar and the circumferential foreskin closure
was completed as usual.
Results
At a mean follow-up of 10 months, two patients developed urethral fistula (2%), six
had meatal stenosis (5%), and two had glans dehiscence (2%) that resulted in meatal
retraction. Overall, patients had a cosmetically satisfying appearance (Figure). Forty-one
received secondary circumcision; the parents of 80 (66%) patients were satisfied with
the final foreskin appearance obtained with this method.
Discussion
The split wings of the glans penis or so-called ventral cleft between the glans wings
that accommodate the frenulum is part of normal anatomy. Hence, in hypospadias surgery,
the approximated glans wings should allow for ventral support of the glanular and
subcoronal urethra through a reconstructed neo-frenulum. Neither glanular surface
enhancement nor extensive dissection of the glans wings and their full-length approximation
are necessary, and may in fact be counter-productive.
Conclusions
Graphical AbstractPre-operative and postoperative images of a patient operated with the GFC technique.1
Keywords
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Article info
Publication history
Published online: November 02, 2016
Accepted:
September 23,
2016
Received:
February 26,
2016
Identification
Copyright
© 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
