Male and female urinary incontinence from the viewpoint of the pelvic floor surgeon

From the perspective of pelvic floor surgery, stress urinary incontinence and urge incontinence are caused primarily by pelvic floor defects, which can be described as loosening of visceral ligaments and fascias. While stress urinary incontinence is mainly associated with defects in the anterior zone, urge incontinence can be caused by loosening in any zone of the pelvic floor. New insight into the pathophysiology of these dysfunctions, which are described here in detail, enabled the development of new surgical procedures from 1986 onwards. The midurethral tape procedure removes looseness in the anterior zone and can usually cure stress urinary incontinence. In patients with urge incontinence, extensive diagnostics are required before an anatomy-orientated reconstruction of the pelvic floor, aimed at establishing a stable vaginal wall beneath the bladder, is indicated. Simulated surgery is important given the complexity of defects and symptoms. Particular attention should be paid to one special case, the "tethered vagina syndrome". This is caused by the scarred and contracted ventral vaginal wall and leads to urinary incontinence. In male stress urinary incontinence, loosening of connective tissue in the sphincter area is postulated as one pathomechanism which can be surgically cured.