Is the cure of severe involuntary urinary loss by surgical repair of the bladder neck area of vagina possible?

Background. Tethered vagina syndrome seems to be an iatrogenic condition caused by scar-induced tightness in the bladder neck area of the vagina. In this regard, the bladder works like a watering can, due to loss of elasticity in the bladder neck area. This situation is somewhat similar to "motor detrusor instability", and is considered as being almost incurable. The first step usually is to free all scar tissue from urethra and bladder neck and the second, to increase the tissue in the bladder neck area of vagina, thereby restoring elasticity. No specific operative procedure was recommended. Purpose. To test the efficacy and safety of the adequate surgical procedure which aim to restore elasticity in the bladder neck area of vagina. Methods. Between January 2001 and December 2009 was performed a plastic operation in the bladder neck area of vagina on 119 patients. In order to permanently improve the continence outcome, "I-plasty" was performed in 13 patients, a free skin graft in 21 patients and finally a bulbocavernosusmuscle- fat-skin-flap-operation from the labium majus in 85 patients. A follow up was performed 5-7 days, 6-8 weeks and 6 month after the operation. All these patients were classified by several physicians as incurable. They were explicitly informed by our team about the principle and aim of the operative procedure as possible attempt to cure the problem. They noticed the trial character of the surgery and signed their agreement on an officially registered sheet. Results. We considered cured painless patients with involuntary urine loss <10 gm during 24 hours. At 6 month review, the cure rate was 3/13 (23%) for I-plasty, 11/21 (52%) for the skin graft and 68/85 (80%) for the bulbocavernosus-flap. Conclusion. In our study, the bulbocavernosus-muscle-fat-skin-flap was the most effective way to cure severe incontinence caused by scarring due to previous vaginal or bladder neck surgery.