Ulaanbaatar procedure for tubularization of the glans in severe hypospadias

PURPOSE: We developed a new procedure for the repair of proximal hypospadias in which the distal urethra is constructed as part of the first of 2 stages, and reviewed the results of 34 cases. MATERIALS AND METHODS: We performed stage 1 of the Ulaanbaatar procedure in 35 children 0.6 to 11 years old (average age 2.5), and stage 2 in 20. The meatus was at the posterior third of the shaft in 14 children, at the penoscrotal junction in 16 and in the perineum in 5. Three patients had a previous operation, and none had Byars flaps formed. Followup was less than 2(1/2) years for stage 1 and less than 1(1/2) years for stage 2. In 2 stage 2 procedures a free graft was also used to augment the proximal part of the urethroplasty. RESULTS: Urethral fistula did not develop in any patient, a minor early stricture occurred in 2 patients and 1 urethral diverticulum occurred in 1 patient after stage 2. In all patients the glans and meatus were more normal compared to other 2-stage procedures after the first operation, and the cosmetic result was usually satisfactory. CONCLUSIONS: The Ulaanbaatar technique provides an alternative approach to the formation of the glans urethra in severe hypospadias. It does not have the risks associated with a single stage procedure but has the benefit of enabling tunneling of the urethra through the glans, thus facilitating a favorable cosmetic outcome and an easy stage 2.