ABSTRACT
Surgery to correct urinary incontinence began in 1852 with a procedure to divert the ureters into the sigmoid colon of a boy with exstrophy.1 Our understanding of the physiology and cause of urinary incontinence has grown slowly over the past century and more has been learned in the past 25 years than in prior medical history. Early surgeons did not have the necessary technology to define the physiology of the bladder neck but they were keen observers of anatomy. As early as 1906 the German surgeon Trendelenburg had suggested to divide the symphysis pubis to gain access for surgical narrowing of the bladder outlet in epispadias patients with the goal of improving urinary control.2 Hugh Hampton Young was the first American urologist to identify the abnormal anatomy of the bladder neck as the cause of the patient’s urinary incontinence and devise surgery to correct it in 1908. In 1919, Young presented his original procedure to provide continence in patients with bladder outlet incompetence.3
