The female pelvic floor

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The objective of this work was to transform stress incontinence surgery from a major procedure requiring up to ten days in the hospital into a minor day-care operation. Key challenges included managing post-operative pain and urinary retention. This journey led to the development of the Integral Theory. The 'tension-free' tape operation was inspired by Dr. Robert Zacharin's anatomical studies, which highlighted the significance of ligaments and muscles around the urethra for urinary continence control, though he did not specify how they functioned. The hypothesis emerged that implanting a plastic tape in the location of the pubourethral ligament would generate enough scar tissue to reinforce this ligament, effectively anchoring the muscles responsible for urethral closure. In September 1986, two prototype Intravaginal Sling operations were conducted, utilizing a Mersilene tape inserted without tension or elevation at the pubourethral ligament site. Both patients experienced immediate restoration of continence and were discharged the following day without the need for catheterization. They reported minimal pain, and after six weeks, the tapes were removed. Remarkably, both patients remained continent at the ten-year follow-up, reinforcing the significance of a midurethral anchoring point.