Complex hypospadias reconstruction: Ulaan Baatar technique revisited

Abstract

Background: Complex hypospadias repair is a challenging issue for the urologists. In Ulaan Baatar technique a distal neourethral tube along with glans is reconstructed in first stage with formation of a controlled fistula between neourethral tube and native urethra proximally. Later in second stage the fistula is closed by traditional technique. Therefore glans and distal urethral tube are not being manipulated during second stage repair and thus it has better cosmetic outcomes.Methods: We reviewed the records of 33 different patients with proximal hypospadias who had undergone Ulaan Baatar repair in last 3 years. 21 patients had multiple previous attempts of hypospadias repair and 12 were primary (naïve) cases with proximal hypospadias.Results: Mean follow up was 18.5 months after first stage and 12.4 months after the second stage. The mean age was 14.1years (ranged 8 to 22 years). Mean time between stage I and stage II was 8 months (range 6-9 months). None of the patients developed fistula, glans dehiscence, meatal stenosis or diverticula formation. All patients had satisfactory cosmetic appearance of glans, distal meatus and shaft.Conclusions: The Ulaan Baatar technique is very safe and effective technique with better cosmetic outcomes and least complication rates. Also the vascularized tunica vaginalis flaps may be used for construction of urethral lumen in complex hypospadias cases when local penile skin is deficient.