ESPU Congress 2018 - Abstract Book

71 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  1 , Seth ALPERT  2 , Daniel DAJUSTA  3 , Christina CHING  3 , Daryl MCLEOD  3 and Molly FUCHS  3 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 st 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