The mystery of Jacob Henle's ‘septum glandis’

Özbey, Hüseyin

doi:10.1111/joa.12965

Cited by 24 publications

(4 citation statements)

References 9 publications

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“…Meanwhile, the corpus spongiosum, which normally surrounds the closed urethra, can be divided into two branches at the site proximal to the ectopic urethral opening and extend along the both sides of the urethral plate in a fan-shaped manner until merging with the glans wing. 6 7 …”

Section: Discussionmentioning

confidence: 99%

Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair

Lyu

Xie

et al. 2021

Asian Journal of Andrology

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We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair. Patients who underwent urethroplasty by dorsal preputial island flap for proximal hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study. Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group, whereas those who underwent conventional glanuloplasty comprised the control group. The incidence of complications was then compared. In the new-maneuver group, dysplastic corpus spongiosum alongside lateral Buck's fascia (0.3–0.4 cm wide) on both sides of the urethral plate was separated from the proximal normal spongy tissue, joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis. In the control group, the neourethra was covered with superficial fascia under the coronal sulcus. As a result, the new-maneuver and control groups comprised 47 and 28 patients, respectively. In the new-maneuver group, no glans dehiscence was detected; however, two (4.3%) patients had coronal fistula, two (4.3%) had urethral stricture, and four (8.5%) had diverticulum. In the control group, two (7.1%) patients had glans dehiscence, eight (28.6%) had coronal fistula, four (14.3%) had urethral stricture, one (3.6%) had diverticulum, and one (3.6%) had penile curvature recurrence. The new-maneuver group had less incidences of coronal fistula ( P < 0.001), glans dehiscence ( P = 0.033), and urethral stricture ( P = 0.008) but had a higher incidence of diverticulum than the control group ( P = 0.040). It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.

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Section: Discussionmentioning

confidence: 99%

Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair

Lyu

Xie

et al. 2021

Asian Journal of Andrology

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“…Standard anatomical texts and most studies describe the "glans penis" as the "anterior (expanded) end of the corpus spongiosum" with diagrams showing the urethra that runs through the glans and is therefore surrounded by spongiosal tissue Cunha, Sinclair, Cao, & Baskin, 2020). Dr Friedrich Gustav Jacob Henle, however, first described the gradual termination of the corpus spongiosum on the fossa navicularis (glanular urethra), the ligamentous structure within the glans and its fine fibrous extensions (septum glandis) around the fossa navicularis (Henle, 1877;Özbey, 2019a). The septum glandis divides the glans into outer and inner layers and holds the glanular urethra in the midline through its two main components: the upper median septum and lower median septum.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, the whole septum glandis was defined as a "urethral ring" and was recently viewed as a "flow control chamber" for urine exiting the urethra (Özbey & Arlı, 2020;von Hayek, 1969). The frenulum is the epidermal extension of the lower median septum, which forms a delta between the glans wings and provides the connection to the foreskin (Henle, 1877;van der Putte, 2007).…”

Section: Discussionmentioning

confidence: 99%

A closer look at iatrogenic hypospadias

2020

Self Cite

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Almost all surgical repair techniques for hypospadias include dissection of the glans penis, and covering the neo-urethra with the glans tissue circumferentially. Surprisingly, the presence of the "septum glandis" in the ventral midline has been overlooked for decades. A careful examination of six patients with iatrogenic hypospadias (IH) revealed direct indications of the septum glandis. All patients were

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“…skin flap (that are not an option in LSA patients) procedures. The fossa owes its transversal elliptical shape from the combination of the higher tissue compliance of the glans spongiosum and Henle's septum glandis (4,5), which tethers the urethra at its 6 and 12 o'clock positions, and seems to func-tion as a urinary "flow control" chamber (6). Indeed, one may conjecture that with time the graft should accommodate to its relatively capacious glanular bed, and acquire a geometric configuration capable of producing a coherent, wave-like, normal voiding stream.…”

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confidence: 99%

Treatment of fossa navicularis strictures

Dias

Ribeiro

2022

Int. braz j urol.

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The article describes the authors' experience with their technique to treat fossa navicularis strictures with ventral buccal mucosa grafts (1). They analyzed complications and outcomes in a retrospective case series of ten patients, selected from their institution's 151-patient strong database. The series included those with synchronous proximal strictures discontinuous with the distal one, i.e. skip strictures; and excluded those with Lichen Sclerosus et Atrophicus (LSA). In all but one patient the stricture resulted from either transurethral surgery or urinary catheterization. The authors achieved a high success rate (by the customary criterion of no further urethral instrumentation): Nine out of ten patients had a favorable functional and aesthetic outcome, and no complications such as urinary fistulae were reported.Their technique is rather straightforward, with few modifications from the original description by Chowdhury at al (2). After cystoscopically ensuring that the distal stricture was limited to the fossa navicularis, a buccal mucosal graft was sutured (with 5-0 polydioxanone) to the mucosal edges of the ventrally incised urethra, with vascular support being provided by both a dartos flap and a glans spongiosum 2-layered closure. In narrower strictures, a dorsal Asopa-like (3) graft was used to augment the urethral lumen.This paper timely addresses one of our most vexing complications: A fossa navicularis stricture after transurethral surgery or urethral instrumentation, which the practicing urologist will inevitably encounter many times during his or her career. Thus, knowledge of treatment options other than dilatation or simple ventral meatotomy/distal urethrotomy looks like sound individual policy. The latter procedures, however simple, effective and widely taught as they are, often lead to aesthetically unfavorable outcomes, which may compromise the patient-physician relationship.Yet, the question whether the procedure should be performed by any urologist or by a specialist, that is, an experienced reconstructive urologist, has a less clear-cut answer. Although the authors claim that the operation has a short learning curve, it does require buccal mucosal harvesting and exquisite technique to handle both graft and graft bed, which may fall outside the scope of many urologists trained during the bygone "direct visual urethrotomy era". Perhaps the new generation of urologists, trained in the ongoing "reconstructive era", may judge themselves more apt to adopt this technique (or any of its variations that will surely follow). For those lacking proper reconstructive urology training, either during their residency or by going through a reconstructive urology fellowship, it may be wise to address the knowledge gap by referencing these patients to more experienced colleagues, and to involve oneself in these operations until acquiring familiarity with the procedure and with its postoperative care.A subtler point of this procedure is that it may act to preserve some of the hydrodynamic features of the fos...

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The mystery of Jacob Henle's ‘septum glandis’

Cited by 24 publications

References 9 publications

Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair

Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair

A closer look at iatrogenic hypospadias

Treatment of fossa navicularis strictures

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