Bilateral tailoring, dorsal folding: A simple approach for short urethra and incompetent bladder neck in female patients.

Objective: Congenital short patulous urethra in females is rare and can lead to varying degrees of urinary incontinence. Surgical options, including bulking agents, urethral and bladder neck reconstruction, fascial slings, and artificial urinary sphincters, have yielded variable results. Based on Hagen-Poiseuille law, we hypothesized that narrowing and folding the urethral lumen could increase intraluminal resistance without resecting any tissue. This study aimed to apply this surgical technique to a small group of female patients and evaluate its short-term outcomes. Methods: We conducted a prospective case series involving incontinent female patients with incompetent bladder necks and widely open urethras. Exclusion criteria included neurogenic bladder dysfunction. Preoperative assessments included physical examination, urinary tract ultrasound imaging, urine analysis, urine culture, conventional standard urodynamic studies, voiding cystourethrography, and cystourethroscopy. For the surgical repair, a suprameatal 3 to 9 o'clock incision was made, and the urethral tissue was dissected to the bladder neck. A 12 Fr Silastic catheter was inserted, and two parallel rows of vertical sutures were placed from the meatus to the bladder neck, creating a central urethral lumen flanked by two smaller lumens. At 3 months and 6 months, patients were assessed for urinary continence. Results: From March 2019 to April 2022, 13 patients (aged 16-50 years) participated, including six with mild epispadias, three with classic exstrophy epispadias syndrome, two with Conclusion: This study presents a novel, less invasive surgical approach for treating a patulous urethra and bladder neck incompetence in females. It may serve as an alternative to more complex surgical techniques for selected cases.