ESPU Congress 2018 - Abstract Book

11–14 APRIL, 2018, HELSINKI, FINLAND

11:01–11:04

S7-4 (PP)

THE MODIFIED ULAANBAATAR PROCEDURE: REDUCED

COMPLICATIONS AND ENHANCED COSMETIC OUTCOME

FOR THE MOST SEVERE CASES OF HYPOSPADIAS

Venkata JAYANTHI

, Seth ALPERT

, Daniel DAJUSTA

, Christina CHING

Daryl MCLEOD

and Molly FUCHS

1) Nationwide Children's Hospital, Section of Urology, Columbus, USA - 2) Nationwide Children's Hospital, Urology,

Columbus, USA - 3) Nationwide Children's Hospital, Columbus, USA

PURPOSE

The “Ulaanbaatar” procedure for proximal hypospadias was described by Dewan as a modifica-

tion of the classic 2-stage procedure in which the glanular urethra is constructed during the first

stage. During the second stage, the penile skin between native proximal meatus and the distal

reconstructed urethra is tubularized.

MATERIAL AND METHODS

We retrospectively reviewed all patients who completed both stages. The first stage is analogous

to a classic repair with regard to urethral plate division and chordee correction. Our modification

involves creation of a preputial tubularized island flap which is brought through the glans. The

remaining penile skin is used for skin coverage and to bridge the native meatus and the distal

neourethra. Six months later, the midline skin is tubularized reconstructing the urethra from the

proximal meatus to the previously constructed glanular neourethra.

RESULTS

Forty-two boys underwent both stages. Mean age at 1

stage was 14.5 months (range 6–118).

Twenty-seven had genital ambiguity(64 %). Thirty-eight (90 %) received pre-operative androgens.

After urethral plate transection, persistent curvature was addressed with dorsal plication in 12,

urethral plate transection alone in 6 or ventral grafting with small intestinal submucosa (SIS) in 24.

Eighty-one % required no futher surgery. Five patients (12 %) developed a urethral diverticulum that

required repair. One developed recurrent epididymitis related to an abnormal ejaculatory duct (no

stricture) and underwent vasectomy. Only two patients developed a fistula. Another required redo

penoscrotal transposition repair. Mean length of follow up is 20.8 months.

CONCLUSIONS

Fistulas are uncommon with this procedure as the gap left after the first stage serves as a controlled

fistula, allowing the penile tissue to heal. This technique may improve the cosmetic appearance as

the glans is only touched once and for the majority, no formal glanuloplasty is needed.

11:04–11:15

Discussion