© 2015 American Urological Association Education and Research, Inc. Purpose Bladder neck closure is an uncommon procedure that is usually reserved for patients with severe urethral incompetence. It may be an acceptable alternative to procedures involving bowel reconstruction. Bladder neck closure can be performed using a transvaginal or a retropubic approach. We compared urethral continence rates, perioperative outcomes, short-term and long-term complications, subsequent procedures and changes in renal function between transvaginal and retropubic bladder neck closure in females at our institution. Materials and Methods We retrospectively reviewed the records of 64 female patients who underwent bladder neck closure with suprapubic catheter placement from May 1990 to February 2013. Baseline variables and the mentioned outcomes were compared between transvaginal and retropubic bladder neck closure. Results There were 35 women in the transvaginal group and 29 in the retropubic group. Urethral erosion due to a chronic indwelling urethral catheter was the most common indication for bladder neck closure. The urethral continence rate after the first bladder neck closure did not significantly differ between the transvaginal and retropubic groups (85.7% vs 81.5%, p = 0.74). The transvaginal group had significantly shorter mean operative time (78.0 vs 137.5 minutes, p = 0.002) and hospital stay (1.5 vs 4.9 days, p = 0.0003), and fewer short-term complications (5.7% vs 31.0%, p = 0.02) than the retropubic group. The remaining outcomes did not differ between the 2 groups. Conclusions There was no difference between transvaginal and retropubic bladder neck closure in achieving urethral continence. Transvaginal bladder neck closure was associated with a shorter operative time and hospital stay as well as fewer short-term complications.