Midline Glanulopexy

O. Shaeer, K. O.K.M. Shaeer Jr., K. Shaeer

Glanspexy, Glanulopexy, Glanular hypermobility, SST deformity, glans drop, floppy glans, penile implant, penile prosthesis

Glans hypermobility (glanular drop, SST deformity, floppy glans) is characterized by ventral or lateral deflection of the glans penis 1. Traditionally, glanspexy is performed using one or more non-absorbable sutures, anchoring the glans to the lateral tunica albuginea or the overlying tissues 1, 2. This is performed on one side if deflection is lateral, or on two sides if deflection is ventral. Lateral is where the dorsal nerves course and fan out. We propose a method to repair ventral glans drop with glans anchoring performed in the dorsal midline, thereby avoiding injury of the dorsal nerves, and avoiding needle puncture of the inflatable penile implant cylinders. 

This video demonstrates a case of glans drop, noted upon penile prosthesis implantation, due to distal corporal scarring that resisted dilatation. Through a subcoronal incision, a non-absorbable 2/0 Polyester suture is passed subcutaneously through the undersurface of the glans, then either adjacent and parallel to the deep dorsal vein, or across the vein. Tying this suture with one limb pulled down achieves anchoring of the glans. 

When glans hypermobility is detected intra-operative, the implant cylinders can be pulled out of the corporotomies as the anchoring suture is being placed. When a patient presents with hypermobility post-implantation, the technique at hand can be performed with the cylinders in-situ and deflated, considering that the anchoring suture is placed in the midline, sparing the cylinders from needle injury.

None. 

None. 

1. Ziegelmann MJ, Alom M, Bole R, Kohler T, Trost L. Modified Glanulopexy Technique for Supersonic Transporter Deformity and Glanular Hypermobility in Men With Penile Prostheses. J Sex Med. 2018;15: 914-19.

2. Mulhall JP, Kim FJ. Reconstructing penile supersonic transporter (SST) deformity using glanulopexy (glans fixation). Urology. 2001;57: 1160-2.