Topographic Labeling of Glans Penis and Corpus Spongiosum When Planning Surgery for Distal Hypospadias

BACKGROUND: Outcomes of hypospadias surgery continually lagged behind anticipations among practitioners, prompting continuing refinement of approaches. Refinements typically involved modified surgical techniques. OBJECTIVE: Herein, the author aimed for reporting the comparative anatomical topography of distal hypospadias anomaly vs normal controls, to boost its reparative approach. PATIENTS AND METHODS: This is a prospective clinical study of distal hypospadias cases presented to the author's facility between June 2018 and June 2020. Anatomical topography of the hypospadias penis was studied concerning the corresponding marks in another control cohort with normal penile development. Meatal marks, glans wings alignment, frenulum, and corpus spongiosum were the anatomical landmarks looked into. Operative correction of the anomaly was carried out considering these landmarks, aiming for pinpoint reassembly. The control group served to identify the normal topography. RESULTS: The author studied 49 cases of distal hypospadias and 10 uncircumcised boys with an otherwise normal penile anatomy. In distal hypospadias, the corpus spongiosum splayed out - at about mid-penile level - ending at a consequently splayed glans penis, rather than involving a primary glans defect. After the corpus spongiosum had been closed/zippered up, no further glans wings' surgical dissection was deemed necessary to attain the anatomical topography identified by the control group. By the end of a median follow-up period of 14 months, no urethrocutaneous fistulae or meatal stenoses were reported, with a typical apical re-assembled meatus, glans ventrum, and frenulum. CONCLUSION: Topographic mapping against control subjects revealed that the glans penis is fully developed in boys with distal hypospadias. After the spongiosal plate has been adequately zippered up, no glans wings' surgical dissection was deemed necessary to attain the typical glanular topography identified by the control group.