Congenital female epispadias with incontinence.

Six cases are described of congenital female epispadias and incontinence. Of these patients 3, who were seen in the last 4 years, were made continent by a 1-stage operation using a combined perineal and transvesical approach. The procedure includes excising the abnormally wide roof of the distal urethra from below narrowing the urethral caliber and mons plasty. From above the upper urethra and bladder neck are narrowed. Ureters are reimplanted if they have reflux or to facilitate bladder neck narrowing. The 3 other cases are described in which this combined procedure could have been used, in retrospect, to obtain a satisfactory result with fewer operations. In female epispadias complete repair of the abnormally wide urethra is better than other alternatives that have been proposed for treating this rare malformation.