Dewan P A, Erdenetsetseg G, Chiang D
Sunshine Hospital, Kids Urology Research Group, Department of Pediatrics, University of Melbourne, Victoria, Australia.
J Urol. 2004 Mar;171(3):1263-5. doi: 10.1097/01.ju.0000113425.79116.b6.
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.
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.
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.
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.
我们开发了一种修复近端尿道下裂的新方法，其中将远端尿道构建为两阶段手术中第一阶段的一部分，并回顾了34例患者的结果。
我们对35名年龄在0.6至11岁（平均年龄2.5岁）的儿童进行了乌兰巴托手术的第一阶段，对20名儿童进行了第二阶段手术。尿道口位于阴茎体后三分之一处的有14名儿童，位于阴茎阴囊交界处的有16名，位于会阴部的有5名。3例患者曾接受过手术，均未形成拜尔斯皮瓣。第一阶段的随访时间少于2.5年，第二阶段的随访时间少于1.5年。在2例第二阶段手术中，还使用了游离移植物来扩大尿道成形术的近端部分。
所有患者均未发生尿道瘘，2例患者术后早期出现轻度狭窄，1例患者在第二阶段术后出现1个尿道憩室。与其他两阶段手术相比，所有患者在第一次手术后龟头和尿道口更为正常，外观效果通常令人满意。
乌兰巴托技术为重度尿道下裂的龟头尿道形成提供了一种替代方法。它没有单阶段手术的风险，但具有使尿道通过龟头隧道化的优点，从而有利于获得良好的外观效果和简化第二阶段手术。
