We studied the effectiveness of tubularized bladder neck reconstruction in the treatment of 8 patients with complex incontinence using urodynamic and clinical methods. The patients had undergone Tanagho bladder neck reconstruction within the last 10 years. Three of the 8 patients were judged unsuitable for artificial sphincter implantation because of severe
scarring, and loss of urethral and vaginal tissue. There were 7 women with
epispadias or severe urethral damage as a consequence of obstetrical or gynecological procedures. Five patients underwent 7 concurrent procedures at the time of bladder neck reconstruction, including colposuspension (4), and closure of a
fistula involving the bladder neck (1) and urethra (1) plus vaginal reconstruction (1). Of 8 patients 5 (63%) were completely continent and satisfied, 2 underwent
ileal conduit diversion (1 because of incontinence and 1 refused clean intermittent self-catheterization), and 1 is incontinent and awaiting further treatment. The best results were noted in patients with a healthy bladder and periurethral tissues. Four of 5 patients (80%) deemed potentially suitable for
artificial urinary sphincter insertion were satisfied compared to only 1 of 3 (33%) unsuitable for
artificial urinary sphincter insertion. The Tanagho bladder neck reconstruction is a useful addition to the procedures that may be used by the reconstructive urological surgeon in the treatment of carefully selected patients with complex incontinence, particularly in women with
epispadias who for various reasons may wish to avoid the long-term potential complications of an
artificial urinary sphincter.