Construction of female urethra from vaginal wall and a perineal flap

Five incontinent girls between 4 and 18 years old were made continent by constructing in each case a long extension of the urethra up to the clitoris. Previous operations at the proximal end of the urethra, to narrow the bladder neck, had not achieved continence. Lengthening the urethra was accomplished by tubularizing the anterior vaginal wall and covering that with a generous pedicle flap from the perineum. The base of the pedicle flap was divided later, restoring the introitus to a normal appearance. Of the 5 patients 3 had the underlying problem of ureteral ectopia with congenital deficiency of the urethra and the bladder neck, 1 had a marked degree of female hypospadias with absence of the distal urethra and in 1 the cause for incontinence was extensive internal urethrotomy during early childhood. This procedure should be applicable to certain difficult cases of incontinence in pediatric and adult patients.