The age of presentation of congenital genital anomalies in developing countries is older than the age in developed countries because of ignorance, illiteracy, unavailability of medical care, and unaffordability. 1 Bhat A. Extended urethral mobilization in incised plate urethroplasty for severe hypospadias: variation in technique to improve chordee correction. J Urol. 2007; 178: 1031-1035 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The technique differs not merely in the use of double breasting, but also because it includes perineal urethroplasty, pelvic floor repair, and genitoplasty in a single stage, is the least morbid, and uses urethral factors for continence. The functional length of the female urethra is 2.4 to 2.8 cm and covers the proximal two thirds of the urethra. To maintain continence, the urethral lumen must be completely sealed. Continence is not only a function of the bladder neck alone. Properties of the urethral wall undoubtedly play a significant role. Urethral wall tension develops within the outer layers of the urethra and is a product, not only of active characteristics of the smooth and striated muscle, but also of the passive characteristic of the elastic tissue and collagenous tissue. 2 Arsdalen K.V. Wein A.J. Physiology of micturition and continence. in: Krane R.J. Siroky M.B. Clinical Neurourolgy. 2nd ed. Little Brown, Boston1991: 25-82 Google Scholar In our procedure, the denuded area was 10 mm in the bladder neck and tapered lower down to 5 mm at the neomeatus. Urethral double breasting helps to keep the symmetry of the bladder neck and urethra, as well as in maintaining the lumen and pressure in the proximal urethra. Thus, it maintains the functional urethral length. Double breasting of the urethra also helps to keep the urethroplasty intact. Thus, double breasting of the bladder neck and urethra both help in achieving continence. We had the advantage of having slightly older patients, but the technique is feasible even in younger patients because the area of double breasting (10 mm) lies in the bladder neck and proximal urethra and then tapers distally. The puborectalis and bulbocavernous are approximated in the midline by partial detachment from the pubic rami, which helps in continence without osteotomy. Osteotomy will definitely help in the proper approximation of the pelvic floor muscles and continence. Pubic diastasis (measured 5.5 cm) is in an adult female, and is measured in plane X-ray; therefore, it is slightly more (approximately 10% magnification in X-ray) 3 Curry III, T.S. Dowdey J.E. Murry R.C. Geometry of radiographic image. in: Christen's Introduction to Physics of Diagnostic Radiology. 3rd ed. Lea & Febiger, Philadelphia1984: 152-160 Google Scholar than the real one. The results were that 2 of the patients became fully continent and another patient who had nocturnal incontinence responded to anticholinergics and became continent. Thus, 3 patients became continent after the single-stage procedure, and the fourth patient who had undergone the Young-Dees procedure earlier was partially incontinent. She became continent after double breasting. Thus, all patients achieved continence. We agree with the editorial comment that bladder neck elevation can be done without more mobilization, which will again help in continence, and we plan to add this maneuver to our procedure to enhance continence in the future. The bladder capacity and voided volumes varied from 150 to 250 mm in the younger patients and 250 to 400 mm in the adults, as shown in the ultrasound scan. The rarity of the condition and a lack of awareness among general practitioners and the referring doctors about the condition and the possible surgical treatment made it difficult to have a larger series. More publications and discussions on the subject will make family physicians more aware of the condition, which will help in having larger series. Hopefully, a combined study will be done at multiple centers to resolve the problems of female epispadias in the future. We thank the learned editor for the compliments about the figures and overview of the published data.