Cystourethropexy was performed in 10 bitches with refractory urinary incontinence due to urethral sphincter mechanism incompetence. All animals had an abnormally shaped vesico-urethral junction. The bladder neck was located in the pelvic canal in nine dogs (pelvic bladder). Surgery alone restored urinary continence in two cases and markedly improved incontinence in two cases. Surgery combined with medical therapy (phenylpropanolamine, 1.5 mg/kg orally once or twice a day, using a sustained-action preparation) restored urinary continence in four cases and markedly improved continence in one case. Surgery, with medical therapy, was completely ineffective in one case. No major complications were encountered in any dogs. In four cases, histopathologic evaluation of the dorsal bladder wall and neck revealed the presence of a single, perinuclear, clear vacuole in the cytoplasm of smooth muscle fibers. Electron microscopic examination showed that the vacuoles represented a dilatation of normal membrane organelles. Such abnormalities have the potential to alter the smooth muscle motility. This study indicates that cystourethropexy alone restored urinary continence only temporarily in the majority of the patients. The significance and frequency of the histopathologic findings requires further investigation.