Research Article| Volume 19, ISSUE 1, P37.e1-37.e7, February 2023

The use of a modified tanagho flap in the repair of posterior urethral stricture after primary exstrophy closure

Published:October 18, 2022DOI:



      In patients with classic bladder exstrophy (CBE), posterior urethral strictures after primary bladder closure can be difficult to manage and therefore necessitate alternative techniques in reconstruction of the proximal urethra. There is a paucity of literature describing treatment and management of posterior urethral stricture arising after repair of classic bladder exstrophy.


      To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho anterior detrusor flap in the treatment of posterior urethral stricture arising after repair of classic bladder exstrophy.

      Patients and methods

      A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients who underwent bladder neck or proximal urethral reconstruction with modified Tanagho flap for proximal urethral stricture disease from the time period of 1975–2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy who underwent proximal urethral reconstruction with modified Tanagho flap were identified. Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not posterior urethral stricture, and was thus excluded from this report. Outcomes measured included post operative bladder capacity, post-operative continence status, upper urinary tract status, and stricture recurrence.


      Four male patients with CBE were treated for posterior urethral strictures and are reviewed here. Three patients underwent successful primary closure (1 via modern staged repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)), and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean age at BNR Tanagho flap was 3.8 (range 2.3–5.0) years. All patients remained stricture free with post-operative urinary incontinence; 2 patients underwent subsequent elective bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1–15.6) years.


      All 4 patients had excellent long term success rates, comparable to results reported in several adult studies utilizing a modified Tanagho flap in women with post-traumatic bladder neck contractures. In addition, our technique described here shares similarities with both the originally described Tanagho flap as well as with a dorsal onlay graft urethroplasty.


      Figure thumbnail fx1
      Graphical AbstractA-E: Cystotomy with creation of modified Tanagho Flap.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gearhart J.P.
        • Baird A.D.
        • Lais A.
        The failed complete repair of bladder exstrophy: insights and outcomes.
        J Urol. 2005; 174
        • Baker L.A.
        • Jeffs R.D.
        • Gearhart J.P.
        Urethral obstruction after primary exstrophy closure: what is the fate of the genitourinary tract?.
        J Urol. 1999; 161
        • Flocks R.H.
        • Cukp D.A.
        A modification of technique for anastomosing membranous urethra and bladder neck following total prostatectomy.
        J Urol. 1953; 69
        • Tanagho E.A.
        • Smith D.R.
        Clinical evaluation of a surgical technique for the correction of complete urinary incontinence.
        J Urol. 1972; 107
        • Tanagho E.A.
        Bladder neck reconstruction for total urinary incontinence: 10 Years of experience.
        J Urol. 1981; 125
        • Surer I.
        • Baker L.A.
        • Jeffs R.D.
        • Gearhart J.P.
        Modified young-dees-leadbetter bladder neck reconstruction in patients with successful primary bladder closure elsewhere: a single institution experience.
        J Urol. 2001; 165
        • Schaeffer A.J.
        • Stec A.A.
        • Purves J.T.
        • Cervellione R.M.
        • Nelson C.P.
        • Gearhart J.P.
        Complete primary repair of bladder exstrophy: a single institution referral experience.
        J Urol. 2011; 186
        • Lee B.R.
        • Perlman E.J.
        • Partin A.W.
        • Jeffs R.D.
        • Gearhart J.P.
        Evaluation of smooth muscle and collagen subtypes in normal newborns and those with bladder exstrophy.
        J Urol. 1996; 156
        • di Carlo H.N.
        • Manyevitch R.
        • Wu W.J.
        • Maruf M.
        • Michaud J.
        • Friedlander D.
        • et al.
        Continence after BNR in the complete repair of bladder exstrophy (CPRE): a single institution expanded experience.
        J Pediatr Urol. 2020; 16
        • Barbagli G.
        • Palminteri E.
        • Rizzo M.
        Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures.
        J Urol. 1998; 160
        • Elkins T.E.
        • Ghosh T.S.
        • Tagoe G.A.
        • Stocker R.
        Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra.
        Obstet Gynecol. 1992; 79
        • Nayyar R.
        • Jain S.
        • Sharma K.
        • Pethe S.
        • Kumar P.
        A novel anterior bladder tube for traumatic bladder neck contracture in females: initial results.
        Urology. 2020; 139