Double-Sided Heinecke-Mikulicz Urethroplasty for Short Stricture Around Penoscrotal Junction: Description of Technique and Clinical Outcome of Initial Cases.

Abstract

Objective: The objective of this study is to describe and clinically review a new surgical technique for treating short stricture around the penoscrotal junction: Double-sided Heinecke-Mikulicz urethroplasty using a ventral approach.

Patients and methods: The study included 11 patients aged 22-83 years affected by urethral strictures around the penoscrotal junction 3-20 mm in length, resulting from transurethral procedures (n = 6), hypospadias repair (n = 3), and trauma (n = 2). The urethra was approached by transperineal penile invagination in eight cases and by penile incision in three cases. In five cases with longer strictures, the distal to mid-bulbar urethra was circumferentially mobilized to avoid anastomotic tension. A ventral midline urethral incision was made from the outside, encompassing the stricture, and the dorsal wall was also incised in the midline from the luminal side. The dorsal incision was sutured longitudinally from the luminal side, and the ventral incision was closed longitudinally from the outside, completing the Heinecke-Mikulicz technique in the dorsal and ventral urethral walls.

Results: The operation time was 92-166 min (median 125 min), and the postoperative observation period was 18-39 months (median 33 months). Two patients developed stricture recurrence, while durable success was achieved in the other nine patients (81.8%). Three patients reported slight penile shortening, but without impairment in sexual activity in Sexual Health Inventory for Men questionnaires.

Conclusions: The present study reports a simple and useful non-transecting urethroplasty technique without using substitutive tissue for treating short urethral strictures around the penoscrotal junction.