Urethral closure remains a last resort treatment of stress urinary incontinence, mainly performed in patients with severe malformations of the lower urinary tract or complex neurologic patients.
Described initially as a technique for closing the bladder neck, this video describes a step by step the procedure of urethral closure by a transvaginal approach.

This surgical intervention concerns a 26-year-old female patient, with the sequelae of a myelomeningocele, multi-operated in childhood, who in the past underwent an augmentation cystoplasty and a continent cutaneous diversion. She also received an autologous sling that failed to improve her stress urinary incontinence. 
In order to solve her stress urinary incontinence due to a severe intrinsic sphincter deficiency and a permanently opened bladder neck, it was decided to perform a​ urethral closure by a transvaginal approach, avoiding another dissection of the Retzius space.

The steps of the intervention include:
- the exposure technique
- dissection of the urethra by a transvaginal approach with a circular per-urethral incision
- multi-layer urethral closure 
- suspension of the urethra to the pubic bone

Operative time was 75 minutes. There were no intraoperative nor  30-day complications. At last follow-up, the patient is fully continent under intermittent self catheterization through​ the continent cutaneous diversion

Closure of the urethra remains a rare intervention as everything must be done to preserve the urethra as much as possible in terms of continence and quality of life. Urethral closure by a transvaginal approach is a good alternative as a last resort treatment for stress urinary incontinence due to severe intrinsic sphincter deficiency. Our step by step technique of urethral closure by a transabdominal approach is reproducible and seems to be a better alternative to an abdominal approach, especially  in multi-operated and multimorbid patients