A timeline of female stress urinary incontinence: how technology defined theory and advanced treatment

Abstract

Background Prevailing theories and treatments of female stress urinary incontinence are built on 120 years of evolution in understanding the structure and function of the female bladder neck and urethra and of considering why treatments failed. In our management of patients, it is important to understand and appreciate how our management of female stress urinary incontinence has evolved and which treatments have prevailed as we advance our knowledge for future treatments. Aims The purpose of this review is to describe how advances in technology impacted and shaped prevailing theories or understanding of the pathophysiology of stress urinary incontinence and influences our treatment approach. Materials and Methods An extensive literature search was performed from 1900 to present identifying articles that discussed technological advancements in female urology, theories of female stress incontinence, and treatments. Results The literature from the 20th century to the present shows a nonlinear evolution of the pathophysiological mechanism of stress urinary incontinence (SUI) from a notion of SUI and secondary to a simple anatomic finding to consideration of the effects of neurophysiologic pathways on SUI. Slings, however, have been a staple in the management of SUI. Conclusions The pubovaginal sling (PVS) is a procedure that, with minor modifications (graft size, suture preference) has withstood the test of time and maintained its place in the armamentarium of SUI treatment for 100 years. It is therefore imperative that we continue to educate our residents and fellows on the surgical techniques and indications for use of the PVS.

Denonvilliers’ fascia acts as the fulcrum and hammock for continence after radical prostatectomy

“…DeLancey [ 20 ] delineated endopelvic fascia and anterior vaginal wall as the hammock-like supportive layer of urethra, which could stabilize and help to close urethra during cough. Sling, placing a supportive material behind urethra, had been a staple procedure for SUI and withstood the test of time [ 21 ]. Back to continence after RP, we hypothesized “hammock theory” still work on and preferred DF to be the critical structure (Figs.…”

Denonvilliers’ Fascia Acts as the Fulcrum and Hammock for Continence After Radical Prostatectomy

“…DeLancey [20] delineated endopelvic fascia and anterior vaginal wall as the hammocklike supportive layer of urethra, which could stabilize and help to close urethra during cough. Sling, placing a supportive material behind urethra, had been a staple procedure for SUI and withstood the test of time [21] . Back to continence after RP, we hypothesized "hammock theory" still work on and preferred DF to be the critical structure (Figure-1, 2 and Figure -4), which could uplift vesicourethral anastomosis.…”

Invited Commentary: Beyond female stress urinary incontinence

“…Although a recently updated systematic review and Metaanalysis showed several advantages for MUS, traditional Burch colposuspension and autologous fascial slings still have their status and indications. [8][9][10] New guidelines state that these are all the same. [11] Invited Commentary…”

“…Recently, serious complications from synthetic materials in MUS and POP mash repair have aroused certain controversy, which has prompted professionals to reappraise it. Although a recently updated systematic review and Meta-analysis showed several advantages for MUS, traditional Burch colposuspension and autologous fascial slings still have their status and indications [8–10] . New guidelines state that these are all the same [11]…”