The integral theory of female stress incontinence is not scientifically sound

What is it about?

Tension-free vaginal tape (TVT) surgery for stress urinary incontinence (SUI) has an overall failure rate of 10-20%. However, the failure rate is much higher for women with hypomobile SUI, and many women who are cured of SUI have de novo or persistent symptoms of urgency and frequency. This suggests that a problem exists. The rationale for TVT surgery is based on the integral theory (IT). Although a correct theory should be able to discriminate between appropriate and inappropriate surgery, IT cannot do this. However, instead of confronting the problems with the theory, failures are blamed on the pathophysiology of SUI, which is alleged to be too multifactorial to be rectified by a single procedure. Therefore, the rationale for IT must be challenged.

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Why is it important?

TVT surgery according to IT has high failure rates because it does not principally prevent urethral hanging on the bladder. In the case of a long urethra, the tape is too distally set. In the case of hypomobile SUI, the use of a suburethral tape is unwarranted because the proximal urethra (v.p.) is not elevated above its resting position. Attempting to “cure” hypomobile SUI without lifting the proximal urethra above its resting position results in high failure rates. To create a lift without the risk of obstruction, the surgeon can use the “TVT technique” to insert one tuned tape in the paraurethral tissue on each side of the v.p

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