Hypospadias repair with the glanular-frenular collar (GFC) technique


Ozbey H., Etker S.

Journal of Pediatric Urology, vol.13, no.1, 2017 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 13 Issue: 1
  • Publication Date: 2017
  • Doi Number: 10.1016/j.jpurol.2016.09.016
  • Journal Name: Journal of Pediatric Urology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: Hypospadias, Penis, Glans penis, Frenulum, Urethroplasty, GENITOURINARY SYSTEM, MUCOSAL COLLAR, MALE URETHRA, ORIGIN, PLATE
  • Istanbul University Affiliated: Yes

Abstract

© 2016 Journal of Pediatric Urology CompanyBackground 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 The employment of a GFC provided: 1) an anatomical restoration of the distal (glanular and subcoronal) urethra, supported by a frenulum; 2) a protective (undissected) dartos layer over the distal part of the tubularized neourethra; and 3) a space for the re-formation of the fossa navicularis.[Figure presented]