Deepithelized glans reconfiguration: A kaleidoscopic view considering the protopathic sensibility of the glans penis

  • Sachit Anand
    Affiliations
    Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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  • Hüseyin Özbey
    Correspondence
    Correspondence to: Hüseyin Özbey, Department of Pediatric Surgery, Division of Pediatric Urology and Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia, Tel.: +905325403720 (mobile)
    Affiliations
    Department of Pediatric Surgery, Division of Pediatric Urology and Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Published:December 16, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.005
      We read the recent article by Alshammari et al. [
      • Alshammari D.
      • Harper L.
      Deepithelialized glans reconfiguration (DeGRe) for distal hypospadias repair.
      ] with great interest and would like to congratulate the authors for presenting their new technique. However, there are certain issues that need to be highlighted. First, the authors have re-emphasized our previous work [
      • Özbey H.
      • Kumbasar A.
      Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications.
      ] and have mentioned that the penile urethra actually terminates at the mid glans level, and not the tip of the glans. However, they have failed to replicate and follow one of the major conclusions of that paper, i.e. glans wings are separated by the septum glandis and the frenulum. A complete glans wrap all around the urethra is non-anatomical and is counterproductive [
      • Özbey H.
      • Etker Ş.
      Hypospadias repair with the glanular-frenular collar (GFC) technique.
      ]. Second, we have strong reservations regarding this technique, which appears to be more of a glans reduction rather than reconfiguration. It is believed that the cosmesis will be unfavorable in long term due to loss of glanular tissue on the ventral aspect. It can lead to varying degrees of glanular tilt (in a resting state or during erection) which dissolves the purpose of this new technique. We will be eager to look at the long-term results and not just a maximum follow-up of 12 months. Third, the deepithelization of the glans comes with a cost. Although the authors have highlighted a strategy of careful deepithelization superficial to the spongiosum, it is impossible to prevent the loss of sensory corpuscles. The genital end bulbs, which are predominant in the corona glandis and frenulum will suffer a major loss while performing this technique [
      • Halata Z.
      • Munger B.L.
      The neuroanatomical basis for the protopathic sensibility of the human glans penis.
      ]. Finally, this technique described by the authors has similarities with the original description of the glans approximation procedure (GAP) procedure by Zaontz et al. [
      • Zaontz M.R.
      The GAP (glans approximation procedure) for glanular/coronal hypospadias.
      ]. Both have utilized the principle of partial deepithelization of the glans penis.
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      References

        • Alshammari D.
        • Harper L.
        Deepithelialized glans reconfiguration (DeGRe) for distal hypospadias repair.
        J Pediatr Urol. 2021; 17: 59.e1-59.e8https://doi.org/10.1016/j.jpurol.2020.10.005
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        Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications.
        Turk J Urol. 2017; 43: 525-529https://doi.org/10.5152/tud.2017.00334
        • Özbey H.
        • Etker Ş.
        Hypospadias repair with the glanular-frenular collar (GFC) technique.
        J Pediatr Urol. 2017; 13: 34.e1-34.e6https://doi.org/10.1016/j.jpurol.2016.09.016
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        The neuroanatomical basis for the protopathic sensibility of the human glans penis.
        Brain Res. 1986; 371: 205-230https://doi.org/10.1016/0006-8993(86)90357-4
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        J Urol. 1989; 141: 359-361https://doi.org/10.1016/S0022-5347(17)40766-X
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