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

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.