Extended Ulaanbaatar Procedure with Preputial Skin Graft for Proximal Hypospadias

Area of Science:

• Urology
• Pediatric Surgery

Background:

• Two-stage urethroplasty for proximal penile hypospadias is associated with significant time, cost, and trauma.
• Single-stage procedures, while less traumatic, are technically demanding.

Purpose of the Study:

• To describe the Extended Ulaanbaatar Procedure (EUP), an innovative single-stage surgical technique for proximal penile hypospadias.
• To evaluate the efficacy and outcomes of EUP in patients with moderate to severe chordee.

Main Methods:

• The EUP involves orthoplasty and full-length urethroplasty with a preputial skin graft in a single stage.
• Urination is temporarily diverted through a proximal hypospadiac meatus, serving as a "controlled fistula" closed six months later.
• Chordee was excised, and the native urethral plate was bridged with a preputial skin graft, utilizing a tunica vaginalis flap for reconstruction.

Main Results:

• Of 35 patients, 32 achieved a vertical meatus in the glans.
• Twenty-nine patients demonstrated satisfactory curve correction and good urinary flow post-surgery.
• Complications included glans dehiscence (1), medium-sized fistulas (2), neourethral stenosis (2), and suture track fistulas (6).

Conclusions:

• The EUP is a less invasive, extended single-stage procedure for proximal penile hypospadias, avoiding repeat trauma and reducing morbidity.
• This technique streamlines the surgical process, potentially lowering costs and hospital stay compared to traditional two-stage methods.
• The primary urethroplasty in EUP, combined with controlled urinary diversion, effectively manages potential complications like disruption or stenosis.