Congenital short patulous urethra in female is a rare event that may present with various degrees of urinary incontinence. According to Poiseuille's law a hypothesis was established that narrowing the urethral lumen and folding it will increase the intra luminal resistance. The surgical technique was performed in a small group of female patients and the short-term results are evaluated

After Institutional Review Board (IRB) approval for a prospective case series study, we selected bladder- neck incompetent and incontinent female patients with wide open urethra. The exclusion criteria included neurogenic bladder dysfunction.
For the surgical approach, a supra meatal mucosal incision was made at the 12 o'clock position to make a semilunar incision between 3 and 9 o'clock. The dissection was advanced to the bladder neck beneath the pubic symphysis. Then, two parallel rows of separate vertical stiches were made from the meatus to the bladder neck involving dorsal and ventral wall of the urethra at each side. Finally, there was one main urethral lumen located centrally between two smaller urethral lumens. In the next step, these two lateral lumens were approximated at the dorsal aspect of the urethra at the 12 o'clock position to reinforce the urethra.

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 de novo stress urinary incontinence post anterior-posterior repair, one with a failed pubovaginal sling, and one with urethral damage from prolonged catheterization. At 1-year postoperative follow-up, 11 of 13 (85%) patients achieved continence. The two failures were in classic exstrophy patients, who subsequently underwent augmentation ileocystoplasty and bladder neck repair.

The study introduces a novel approach for treating urinary incontinence in female patients with epispadias, and potentially other conditions associated with urine leakage. Epispadias, a rare congenital urogenital anomaly, affects about 1 in 480,000 females, though milder forms may go undiagnosed. Various surgical techniques have been attempted to narrow the bladder neck and urethral lumen, with mixed success. For mild epispadias, especially when the urethral circumference is intact, the study proposes a technique involving the insertion of a catheter and bilateral vertical sutures to create a central lumen and obliterate two lateral lumens. This method enhances urethral resistance and leads to improved continence outcomes in patients with mild epispadias.

The study reports an 85% success rate in achieving continence without pads. However, among patients with classic exstrophy, only one out of three showed a full response to the initial surgery, and further procedures were required to achieve dryness. The technique was also effective in patients who had failed previous sling procedures and urethral damage secondary to prolonged indwelling catheter. The study concludes that this novel approach holds promise for improving outcomes in urinary incontinence management in patients with epispadias and related conditions.

Narrowing the urethral lumen through bilateral tailoring and dorsal folding achieved favorable outcomes in 85% of cases for female urinary incontinence with a patulous urethra and dysfunctional bladder neck. This technique may be useful for mild female epispadias, failed anti-SUI surgeries, or bladder neck damage from prolonged catheterization. In classic bladder exstrophy, it could complement major surgeries like augmentation cystoplasty. A minimum 2 cm urethra and a complete urethral circumference are required for the technique. Further studies with larger samples and longer follow-up are needed to assess its role in anti-incontinence surgery.