Falling-down bladder flap reconstruction for recalcitrant bladder neck contracture: One complex case and stepwise technique

This study describes a transvesical "falling-down" anterior bladder wall flap reconstruction for recalcitrant bladder neck contracture (BNC). One complex case, a rotated, well-vascularized bladder flap was sutured to the distal urethra/prostate bed after wide bladder exposure. A 49-year-old man underwent combined procedures with diverticulectomy and ureteral reimplantation, achieving normal uroflow (Qmax 17 mL/s) and no residual urine for three years. The falling-down bladder flap offers durable tissue and wide exposure to facilitate concomitant repairs and may complement traditional BNC techniques.