Tanagho Anterior Bladder Tube
The Tanagho anterior bladder tube uses tubularized anterior bladder wall to reconstruct the bladder neck and proximal urethra. Tanagho described it for total urinary incontinence; the 1981 series of 50 anterior tube repairs (plus 6 after retropubic prostatectomy) was compared with 25 posterior (Leadbetter) tube repairs. Post-prostatectomy incontinence was the main indication (44 patients). Other indications were trauma, congenital anomalies including epispadias, urethrotomy and urethral excision. Success with the anterior repair was about 70%.[1] It is a historical technique with selected salvage uses.[1][2] The classic Tanagho tube is not listed as a first-line procedure in EAU 2026 guidance, which recommends TUR or hot-knife DVIU first for nonobliterative BNS after benign-prostate surgery and visually controlled dilatation or DVIU first for nonobliterative VUAS .[12]
Concept and operative principles
A vascularized strip of anterior bladder wall is fashioned into a mucosa-lined tube and connected to the remaining outlet or urethral target.[1][2] The general sequence is as follows.
- Expose the bladder through a lower midline or Pfannenstiel incision, develop the space of Retzius and mobilize the anterior bladder wall.
- Open the bladder anteriorly to expose the bladder neck and trigone.
- Outline a strip of full-thickness anterior wall, based proximally at the bladder neck and extending cephalad.
- Tubularize the strip over a catheter with the mucosa inward.
- Direct the tube caudally and anastomose it to the urethral stump, or bring it to the perineum.
- Close the donor defect and leave a urethral catheter through the neourethra, usually with suprapubic drainage.
Protect the ureteral orifices and avoid tension or rotation.[1][2][3][4] Tube orientation, dimensions, caliber and catheter regimen vary across the named modifications.[1][2][3][4] In Radwan's female series, both urethral and suprapubic catheters provided drainage. The urethral catheter remained for two weeks, followed within the next week by voiding cystourethrography through the suprapubic catheter. The suprapubic catheter was removed only after satisfactory voiding without extravasation; otherwise imaging was repeated one to two weeks later.[6]
The tube restores outlet length and resistance. It is not a normal striated sphincter. In a canine two-stage bladder-flap neourethra, closure pressure was related to the tone of the smooth muscle tube plus compression by the pelvic floor muscles.[10] Continence and emptying depend on the whole reservoir and outlet system, and obstruction or a need for intermittent catheterization may result.
Original experience and modifications
| Report | Scope | Interpretation |
|---|---|---|
| Tanagho 1981 | 25 posterior and 50 anterior bladder-tube repairs, plus six additional post-prostatectomy applications described | Approximately 70% success in the anterior group. The title's “10 years' experience” is the treatment period, not ten-year follow-up of all 50 patients.[1] |
| Koraitim 1985 | 27 patients: 10 standard anterior tubes, 17 treated with three other configurations | 85% reported overall success. Tailoring was the authors' rationale; no comparator proves that a particular configuration caused a better result.[2] |
| Beck 1979 | Five difficult urethrovesical anastomoses during radical prostatectomy | The tube was anastomosed to the transected urethra. The authors report that it facilitated the anastomosis and improved transient postoperative incontinence. There was no control group.[3] |
| Gallagher 1995 | 8 patients with complex adult incontinence (7 women with epispadias or severe urethral damage after obstetric or gynecologic procedures); 3 were judged unsuitable for AUS because of scarring and tissue loss | 5/8 (63%) completely continent and satisfied; five patients also underwent seven concurrent procedures, including four colposuspensions. Two had ileal conduit diversion; one was awaiting further treatment. 4/5 (80%) potentially suitable for AUS were satisfied, against 1/3 (33%) of those unsuitable. Results were best with a healthy bladder and periurethral tissue.[9] |
| Seaman/Benson 1996 | 29 bladder-neck tubes created during radical retropubic prostatectomy before urethrovesical anastomosis, compared with 30 selected prostatectomy patients without a flap | A 5 cm-base/3 cm-apex flap was tubularized over a 30 Fr catheter. In the reconstruction group, 7/29 were fully continent within 24 hours of catheter removal, 27/29 by 3 months and 28/29 by 6 months; one BNC occurred. The 30 comparison patients were randomly selected from those without a bladder flap, not randomized to treatment. Continence was higher at all follow-up times.[5] |
Seaman's flap dimensions are specific to that modification. A distinct U-shaped anterior bladder-neck tube used during prostatectomy was reported in 2024. At one week after catheter removal, 179/210 treated men versus 22/96 earlier controls met the study's continence definition of zero pads per day and ICIQ-SF score ≤6. This single-center retrospective historical comparison was nonrandomized, excluded men with prior pelvic surgery or radiation, and assessed continence only through 24 weeks.[13]
Female urethral reconstruction
In Radwan's retrospective series, six women with adequate bladder capacity received anterior bladder tubes; ten received labial pedicled tubes because small capacity, extensive adhesions, or a suprapubic catheter close to the pubic bone made a bladder tube unsuitable in those cases.[6] The nine labial-tube patients with follow-up also received a transobturator sling.[6] At mean follow-up of 42 months, complete continence was 4/6 after bladder-tube repair and 6/9 after labial-tube repair; one woman in each group had partial continence, while one and two, respectively, had continence failure. All five women with partial continence or failure needed a secondary procedure.[6] The labial-flap group had one meatal stenosis and two cases of transient retention; anatomical repair succeeded in all patients. The tube was placed through a combined vaginal and abdominal approach. Radwan reported partial continence for the combined cohort; the selected groups were too small for an equivalence comparison.[6]
Nayyar and colleagues cite three limitations of the classic Tanagho repair: the bladder neck is shifted anterosuperiorly, which may impair voiding; the posteriorly directed suture line risks vaginal fistula; and rotational tug on the bladder puts tension on the suture line. Their U-shaped modification was reported in three women with traumatic bladder-neck obliteration, with or without urogenital fistula. It keeps the native bladder neck fibers at the bladder neck. Tube lengths were 3.5, 3 and 3.5 cm, catheters were removed at 3 weeks, and follow-up was 15, 7 and 3 months.[4]
Distinguish other bladder-flap operations
| Procedure | Difference |
|---|---|
| Y-V plasty | Advances a bladder flap into an opened stenosis without constructing a long tube |
| T-plasty | Uses a modified two-flap configuration to widen the outlet |
| Pippi Salle urethral lengthening | Sutures an anterior bladder wall flap to the posterior wall in onlay fashion to create a flap valve, not a circumferential tube. In a 17-child series with neurogenic incontinence or exstrophy, 13 also underwent bladder augmentation. At average follow-up of 25.6 months, 12/17 were continent for more than four hours, two had urethrovesical fistula, and three had catheterization problems.[7][8] |
| Tubularized bladder-flap catheterizable channel | Creates a route for catheterization; its continence mechanism and outlet differ from a Tanagho neourethra. In a retrospective series of 173 channels (median follow-up 12.4 years), no statistically significant difference in revision-free survival was detected between appendicovesicostomy, Monti and tubularized bladder flap channels; 53% of all channels needed at least one revision, and revisions were more common with Monti channels[11] |
See catheterizable channels for that separate application. Some robotic VUAS reports call downward bladder rotation with an anterior cystotomy anastomosed to the urethral stump a 'modified Tanagho flap.' That repair does not create the circumferential tubularized anterior-wall neourethra described here.[15]
Current clinical use
Bladder-tube reconstruction has been reported for female urethral reconstruction after trauma with total urethral loss, complex incontinence in patients unsuitable for AUS because of scarring or tissue loss, and epispadias in women.[6][9] A 2025 retrospective series of a modified tubular anterior bladder-wall flap included 27 mixed-age patients, 16 female. At mean follow-up of 46.6 months in the female group, 10/16 had good urinary control and voiding, 4/16 had stress incontinence, and 2/16 had voiding difficulty; the report states that both underwent endoscopic resection of prolapsed mucosa and meatoplasty.[14] Preoperative urethrography and cystoscopy in the 27-patient flap series showed bladder capacity >200 mL without obvious inflammation.[14] It is considered only after defining the defect, reservoir function, tissue quality, continence mechanism and feasible alternatives. The reports are small, heterogeneous and often include additional procedures; neither reliable spontaneous emptying nor freedom from further continence surgery is guaranteed.[1][2][6][4]
References
1. Tanagho EA. "Bladder Neck Reconstruction for Total Urinary Incontinence: 10 Years Experience." The Journal of Urology. 1981;125(3):321-6. doi:10.1016/s0022-5347(17)55024-7
2. Koraitim M. "Anterior Bladder Tube: 4 Forms for Incontinence of Different Etiology." The Journal of Urology. 1985;134(2):269-73. doi:10.1016/s0022-5347(17)47120-5
3. Beck PH, McAninch JW, Stutzman RE. "Anterior Bladder Tube Flap Reconstruction of the Urethrovesical Neck After Radical Retropubic Prostatectomy." The Journal of Urology. 1979;121(3):379-81. doi:10.1016/s0022-5347(17)56795-6
4. 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;139:201-206. doi:10.1016/j.urology.2019.12.037
5. Seaman EK, Benson MC. "Improved Continence With Tubularized Bladder Neck Reconstruction Following Radical Retropubic Prostatectomy." Urology. 1996;47(4):532-5. doi:10.1016/S0090-4295(99)80490-7
6. Radwan MH, Abou Farha MO, Soliman MG, et al. "Outcome of Female Urethral Reconstruction: A 12-Year Experience." World Journal of Urology. 2013;31(4):991-5. doi:10.1007/s00345-013-1087-2
7. Salle JL, de Fraga JC, Amarante A, et al. "Urethral Lengthening With Anterior Bladder Wall Flap for Urinary Incontinence: A New Approach." The Journal of Urology. 1994;152(2 Pt 2):803-6. doi:10.1016/s0022-5347(17)32715-5
8. Salle JL, McLorie GA, Bägli DJ, Khoury AE. "Urethral Lengthening With Anterior Bladder Wall Flap (Pippi Salle Procedure): Modifications and Extended Indications of the Technique." The Journal of Urology. 1997;158(2):585-90. doi:10.1016/S0022-5347(01)64560-9
9. Gallagher PV, Mellon JK, Ramsden PD, Neal DE. "Tanagho Bladder Neck Reconstruction in the Treatment of Adult Incontinence." The Journal of Urology. 1995;153(5):1451-4. doi:10.1016/s0022-5347(01)67430-5. PMID 7714963
10. Thüroff JW, Hutschenreiter G, Rumpelt HJ, Hohenfellner R. "Neourethra: A New Two-Stage Procedure for Reconstruction of the Functional Urethra." The Journal of Urology. 1983;130(6):1228-33. doi:10.1016/s0022-5347(17)51766-8
11. Polm PD, Christiaans CHH, Dik P, Wyndaele MIA, de Kort LMO. "Continent Catheterizable Urinary Channels: Lessons for Lifelong Urological Care From a Comparative Analysis of Very Long-Term Complications and Revision-Free Survival of Three Different Types." Neurourology and Urodynamics. 2024;43(5):1083-1089. doi:10.1002/nau.25350
12. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Chapter 6, Disease management in males, sections 6.3.5.a.2–6.3.5.a.3. Guideline.
13. Xu Z, Zhao J, Guan Z, et al. "Internal urethral sphincter reconstruction with anterior bladder neck tube for robotic and laparoscopic radical prostatectomy: improving early return of continence." Transl Androl Urol. 2024;13(6):994-1003. doi:10.21037/tau-23-583
14. Zhu WD, Guo H, Xie H, Song LJ, Xu YM. "Neourethra reconstruction using an anterior bladder wall flap for the treatment of complex urethral obliteration and absence." Transl Androl Urol. 2025;14(2):432-440. doi:10.21037/tau-24-443
15. Zhang TR, Alford A, Zhao LC. "Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes." Asian J Urol. 2024;11(3):341-347. doi:10.1016/j.ajur.2023.08.007