Treatment of female incontinence secondary to urethral damage or loss

Damage to the urethra may be functional or anatomic. In the former, to some extent, the urethra functions merely as a tube. Anatomic damage ranges from small urethrovaginal fistulas to total loss of the urethra, vesical neck, and trigone. For functional damage, the goal is compression of the proximal urethra, and the author favors a pubovaginal fascial sling, which is described. In the author's view, the best results in anatomic loss are obtained by performing an appropriate anti-incontinence procedure at the time of urethral reconstruction.