A series of 50 patients presented with total urinary incontinence secondary to traumatic loss of much or all of the urethral floor and bladder neck. Previously, the 50 patients had been subjected to 94 unsuccessful operations; this serves to indicate the challenging nature of the problem. Surgical reconstruction was accomplished by creating a small-caliber neourethra from the contractile tissue that remained in the urethral roof. In addition, 22 of the 50 patients (44 per cent) required a supplemental myocutaneous labial skin flap (12 patients) or a bulbocavemosus muscle flap of the Martius type (10 patients). A "second-stage" retropubic urethrovesical suspension was required in 20 patients. After a follow-up period of five to 15 years, 37 of the 50 patients (74 per cent) were cured and an additional four patients (8 per cent) were greatly improved.