Genuine stress incontinence

This article examines the anatomy of the female continence mechanism and the traditional and newer theories relevant to the etiology and surgical correction of genuine stress incontinence. The authors review the classical theories of incontinence and unify them with more recent ones, stressing that central to all explanations is the concept that urinary loss secondary to an underactive outlet results from a relative lack of continence mechanism resistance with respect to intravesical pressure. They also propose an explanation for the success of newer techniques that involve mid-urethral suspensions. Surgical stabilization of the continence mechanism, at the bladder neck or mid-urethra, compensates for the existing loss of urethral support or function by creating a new zone that provides compression, absorbs transmitted pressure, and preserves sphincteric configuration.