Three patients have been successfully operated with bladder flap procedures for severe functional impairment of the urethra. In two cases total urethral reconstruction was established with a rotary flap (= inverse Boari flap). The third case with recurrent incontinence and instable pelvis was cured by lengthening the urethra analogous the Leadbetter technique. Using a rotary bladder flap tube the whole urethra can be reconstructed. Continence is achieved without suspension procedure of the urethrovesical junction. The neomeatus urethrae internus should be placed as low as possible without injury to the bladder plate. Care must be taken to the blood supply because of the risk of flap necrosis. In case of good blood supply the one-stage urethral reconstruction is recommended.
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