The Glanular-Frenular Collar (GFC) Technique

A clear understanding of the normal anatomy of the penis is essential for anatomical reconstruction of hypospadias. It is necessary to know that the male urethra is NOT a uniform tubular structure and the glanular urethra differs from the penile urethra in that it forms a fossa (navicularis) with a specific shape, with different boundaries, attachments, and elasticity. The fibrous ligamentous framework of the penis is the main component of this difference. Details of penile anatomy that have been completely overlooked in the history of hypospadias surgery include the “septum glandis”, the tunica albuginea, the distal ligament, the navicular fossa, and the flow-dynamics of urine in the male urethra (Özbey and Kumbasar, Turk J Urol. 43:525–9, 2017; Henle, Anatomischer Hand-Atlas zum Gebrauch im Secirsaal (Band 6), 1877; Özbey, J Anat. 234:728–9, 2019; Özbey H, Arlı, Med Hypotheses. 140:109642, 2020). I believe that the surgical process for hypospadias should guide two distinct concepts of surgical repair reserved for the glanular and penile urethra. The Glanular-Frenular Collar (GFC) technique simulates the embryological development of the urethra and aims to provide the structural and functional anatomical features of the glanular and penile urethra in hypospadias (Özbey and Etker, J Pediatr Urol. 13:34e1–6, 2017; Özbey H, J Pediatr Urol 20:539–40, 2024).