ABSTRACT
This chapter reviews the history of urinary incontinence theories and its relation to the development of surgery. It reviews the anatomic basis of continence, history of theories of incontinence, and proposed mechanism behind procedures performed for SUI. Additionally, one might consider that all patients with sphincteric incontinence have some degree of ISD since the normal urethra is intended to remain closed no matter what the degree of stress or rotational descent. In 2006, Daneshgari and Moore, attempted to encompass all previous theories and the multifactorial baseline for incontinence. The final shift of SUI treatments away from retropubic suspensions and toward vaginal slings occurred when Chaikin and colleagues showed that pubovaginal slings work for all kinds of incontinence, including patients thought to have primary hypermobility. They did not offer a mechanism of action for the pubovaginal sling in all cases of SUI, but their results helped move the field away from retropubic suspension and toward a more integrated theory of incontinence.
