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Aim of the study: We have previously described the anatomical details of the normal penis using magnetic resonance imaging. The fibroelastic "septum glandis" covers the fossa navicularis and, together with the frenulum, forms the ventral wall of the glanular urethra. Megameatus-intact prepuce (MIP) is a form of hypospadias characterized by a well-configured glans penis and fossa navicularis, but the absence of the ventral wall of the glanular urethra. The reconstruction of the MIP is demonstrated in a video presentation.

Method: The reconstruction of the MIP in a 2-year-old boy was performed using the Glanular-Frenular Collar (GFC) technique. This video presentation shows how the septum and frenulum are surgically formed between the wings of the glans as the ventral wall of the glanular urethra, as is the case in normal anatomy.

Results: A slit-shaped meatus and a septum with frenulum between the glans wings were created without complications. The patient urinates straight and with a wave-like shape urine stream, as in normal urination. The three-year follow-up was unremarkable.

Conclusions: Contrary to common practice in hypospadias reconstruction, the wings of the glans do not fuse at the ventral midline in normal anatomy. For a functional hypospadias correction, the septum between the glans wings and its epithelial covering (frenulum) must be reconstructed. Patients with MIP-type hypospadias are the best candidates for this type of repair.

Literatur

[1] Özbey H. The mystery of Jacob Henle’s “septum glandis”. Journal of Anatomy. 2019;234:728-729.
[2] Özbey H, Devecioğlu D, Staroverov O. A closer look at iatrogenic hypospadias. Andrologia. 2020;53:e13803.
[3] Özbey H. The facts and misconceptions in hypospadias surgery. J Pediatr Urol. 2020;16:408-409.
[4] Özbey H. Providing a fossa navicularis in reconstruction of hypospadias. Urology. 2021;149:267-268.